Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 270656 | MA |
NPI | 1174961619 |
---|---|
Provider Name | Sarah Christiane Phillips |
First Address | Dorchester, MA 02125-2424 |
Second Address | Dorchester, MA 02125 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2013 |
Last Update Date | 02/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RES000 | (02) |