Provider Demographics
NPI:1225004476
Name:PHILLIS, MD, PLLC, NANETTE D (MD)
Entity Type:Individual
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First Name:NANETTE
Middle Name:D
Last Name:PHILLIS, MD, PLLC
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1815 S CLINTON AVE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-5720
Mailing Address - Country:US
Mailing Address - Phone:585-461-9500
Mailing Address - Fax:585-271-1432
Practice Address - Street 1:1815 S CLINTON AVE
Practice Address - Street 2:SUITE 340
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-5720
Practice Address - Country:US
Practice Address - Phone:585-461-9500
Practice Address - Fax:585-271-1432
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2010-05-03
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Provider Licenses
StateLicense IDTaxonomies
NY195745207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP020195745OtherUNIVERA
NY412186999OtherEMPIRE PLAN
NY01563840Medicaid
NYP010195745OtherRMSCO
NY101517BJOtherPREFERRED CARE
NY5269451OtherAETNA
NYDE2348OtherRAIL ROAD MEDICARE
NYP020195745OtherBCBS OF ROCHESTER
GA412186999OtherUNITED HEALTH CARE
NYP020195745OtherUNIVERA
NY101517BJOtherPREFERRED CARE
NY412186999OtherEMPIRE PLAN