Provider Demographics
NPI:1033132352
Name:FLOMENBERG, PHYLLIS R (MD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:R
Last Name:FLOMENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 CHESTNUT ST
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4316
Mailing Address - Country:US
Mailing Address - Phone:215-955-7785
Mailing Address - Fax:215-955-9362
Practice Address - Street 1:1015 CHESTNUT ST
Practice Address - Street 2:SUITE 1020
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4316
Practice Address - Country:US
Practice Address - Phone:215-955-7785
Practice Address - Fax:215-955-9362
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2019-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053975L207R00000X
PAMD053957L207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001675985Medicaid
NJ7505906Medicaid
PA001675985Medicaid