Provider Demographics
NPI:1437116670
Name:PHILLIES, GREGORY P (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:P
Last Name:PHILLIES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14231-1368
Mailing Address - Country:US
Mailing Address - Phone:716-859-2954
Mailing Address - Fax:716-859-2962
Practice Address - Street 1:100 HIGH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203-1126
Practice Address - Country:US
Practice Address - Phone:716-859-2954
Practice Address - Fax:716-859-2962
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1388622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
040426002635OtherFIDELIS
NY1388628WOtherWORKERS COMPENSATION
P00028819OtherRR MEDICARE
4195933OtherGHI
NY00867092Medicaid
00025345105OtherUNIVERA
5607924OtherINDEPENDENT HEALTH
000525477008OtherBLUE SHIELD WNY
4195933OtherGHI
NYB70995Medicare UPIN
NY00867092Medicaid