Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0402X | Child Neurologist | 142163 | NY |
Y | 2084N0402X | Child Neurologist | MD043817L | PA |
NPI | 1184630543 |
---|---|
Provider Name | Peter C Phillips |
First Address | Philadelphia, PA 19107-3377 |
Second Address | Philadelphia, PA 19104-4319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 25/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001008390 | (05) | PA |
0217409 | (05) | NJ |
D76372 | (02) |