Provider Demographics
NPI:1376596262
Name:CYNTHIA B PHILLIPS DO PA
Entity Type:Organization
Organization Name:CYNTHIA B PHILLIPS DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:TABOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-932-5138
Mailing Address - Street 1:450 MEDICAL CENTER BLVD STE 540
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4232
Mailing Address - Country:US
Mailing Address - Phone:832-932-5138
Mailing Address - Fax:832-932-5142
Practice Address - Street 1:450 MEDICAL CENTER BLVD STE 540
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4232
Practice Address - Country:US
Practice Address - Phone:832-932-5138
Practice Address - Fax:832-932-5142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0510207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179224401Medicaid
0067NJOtherBCBS GR#