Provider Demographics
NPI:1487811881
Name:PATRICIA J. PHILLIPS, DO, PA
Entity type:Organization
Organization Name:PATRICIA J. PHILLIPS, DO, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:207-847-9200
Mailing Address - Street 1:10 FOREST FALLS DR
Mailing Address - Street 2:SUITE 11
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6936
Mailing Address - Country:US
Mailing Address - Phone:207-847-9200
Mailing Address - Fax:207-847-9315
Practice Address - Street 1:10 FOREST FALLS DR
Practice Address - Street 2:SUITE 11
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6936
Practice Address - Country:US
Practice Address - Phone:207-847-9200
Practice Address - Fax:207-847-9315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1166207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME239500000Medicaid
ME239500000Medicaid
MEMM0796Medicare PIN