Provider Demographics
NPI:1003849928
Name:PHILLIPS, SPENCER D (MD)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:D
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 MANOR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-4215
Mailing Address - Country:US
Mailing Address - Phone:717-517-7841
Mailing Address - Fax:717-517-7853
Practice Address - Street 1:2113 MANOR RIDGE DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4215
Practice Address - Country:US
Practice Address - Phone:717-517-7841
Practice Address - Fax:717-517-7853
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029404E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008237Medicaid
PA1008237Medicaid
PA070669KZ9Medicare ID - Type Unspecified