Provider Demographics
NPI:1528375334
Name:SUZANNE L. PHILLIPS, D.P.M., P.C.
Entity Type:Organization
Organization Name:SUZANNE L. PHILLIPS, D.P.M., P.C.
Other - Org Name:BUCKS COUNTY PODIATRY
Other - Org Type:Other Name
Authorized Official - Title/Position:PODIATRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:267-288-5103
Mailing Address - Street 1:1073 SECOND STREET PIKE
Mailing Address - Street 2:
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954-1803
Mailing Address - Country:US
Mailing Address - Phone:267-288-5103
Mailing Address - Fax:267-288-5108
Practice Address - Street 1:1073 SECOND STREET PIKE
Practice Address - Street 2:
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954-1803
Practice Address - Country:US
Practice Address - Phone:267-288-5103
Practice Address - Fax:267-288-5108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005525213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA6460450001OtherPTAN
PA1389267OtherHIGHMARK BLUE SHIELD
PA30080124OtherKEYSTONE MERCY GROUP PROVIDER NUMBER
PA057434YCP8OtherMEDICARE GROUP PROVIDER NUMBER
PA30080124OtherKEYSTONE MERCY GROUP PROVIDER NUMBER