Provider Demographics
NPI:1578975835
Name:PHILLIP, KHADIA M (MD)
Entity Type:Individual
Prefix:
First Name:KHADIA
Middle Name:M
Last Name:PHILLIP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:501 HOWARD AVE
Mailing Address - Street 2:SUITE F2
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-4882
Mailing Address - Country:US
Mailing Address - Phone:814-889-2020
Mailing Address - Fax:814-889-2213
Practice Address - Street 1:501 HOWARD AVE
Practice Address - Street 2:SUITE F2
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-4882
Practice Address - Country:US
Practice Address - Phone:814-889-2020
Practice Address - Fax:814-889-2213
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMT205853207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine