Provider Demographics
NPI:1518069988
Name:PHILLIPS, PATRICIA J (DO)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FOREST FALLS DRIVE
Mailing Address - Street 2:SUITE 11
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096
Mailing Address - Country:US
Mailing Address - Phone:207-847-9200
Mailing Address - Fax:207-847-9315
Practice Address - Street 1:10 FOREST FALLS DRIVE
Practice Address - Street 2:SUITE 11
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096
Practice Address - Country:US
Practice Address - Phone:207-847-9200
Practice Address - Fax:207-847-9315
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1166207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0380OtherCIGNA
MM0796Medicare ID - Type Unspecified
0380OtherCIGNA