Provider Demographics
NPI:1235195058
Name:PHILLIPS, EMILIA (MD)
Entity Type:Individual
Prefix:
First Name:EMILIA
Middle Name:
Last Name:PHILLIPS
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 1:900 CUMMINGS CTR
Mailing Address - Street 2:SUITE 304T
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6198
Mailing Address - Country:US
Mailing Address - Phone:978-998-3154
Mailing Address - Fax:978-998-3156
Practice Address - Street 1:900 CUMMINGS CTR
Practice Address - Street 2:SUITE 304T
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6198
Practice Address - Country:US
Practice Address - Phone:978-998-3154
Practice Address - Fax:978-998-3156
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA232514208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000995801OtherMEDICARE PTAN
340020219OtherRR MEDICARE
MA2165414Medicaid
45988OtherGHI
MA1356593701OtherGROUP NPI
32150487207OtherNATIONAL LETTER CARRIERS
32150487207OtherNATIONAL LETTER CARRIERS
020590007OtherNOVA
80121005251723OtherBLUE SHIELD GM
020590007OtherUNITED HEALTHCARE COM
000525172003OtherCOMMUNITY BLUE
32150487207OtherNATIONAL LETTER CARRIERS
0005251723OtherBLUE CARD
1910080OtherIHA
AA1223Medicare ID - Type Unspecified
62T69OtherEMPIRE BLUE CROSS
020590007OtherUNITED HEALTHCARE EMPIRE
340020219OtherRR MEDICARE
45988OtherGHI
CC8723Medicare ID - Type Unspecified