1285617696 NPI number — JOHN A PHILLIP MD

Table of content: JOHN A PHILLIP MD (NPI 1285617696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285617696 NPI number — JOHN A PHILLIP MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILLIP
Provider First Name:
JOHN
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285617696
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1524 ATWOOD AVE STE 245
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNSTON
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02919-3228
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-443-5559
Provider Business Mailing Address Fax Number:
401-443-5562

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1524 ATWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE 245
Provider Business Practice Location Address City Name:
JOHNSTON
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02919-3228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-443-5559
Provider Business Practice Location Address Fax Number:
401-443-5562
Provider Enumeration Date:
11/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  RI08221 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7002899 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: RI08221 . This is a "STATE LICENSE #" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 1700281 . This is a "UNITED HEALTHCARE #" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 004509 . This is a "BLUE CHIP #" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com