Provider Demographics
NPI:1003950239
Name:PHILLIPS, SIDNEY HORNOR (MD)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:HORNOR
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 1:234 CHURCH ST
Mailing Address - Street 2:SUITE #300
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-1804
Mailing Address - Country:US
Mailing Address - Phone:203-865-8246
Mailing Address - Fax:
Practice Address - Street 1:234 CHURCH ST
Practice Address - Street 2:SUITE #300
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-1804
Practice Address - Country:US
Practice Address - Phone:203-865-8246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0195392084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT30690Medicare UPIN