Provider Demographics
NPI:1609985373
Name:MICALIZZI, PHILIP ANTHONY JR (MD)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:ANTHONY
Last Name:MICALIZZI
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3180 MAIN STREET
Mailing Address - Street 2:STE 302
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606
Mailing Address - Country:US
Mailing Address - Phone:203-372-6505
Mailing Address - Fax:203-372-5622
Practice Address - Street 1:3180 MAIN STREET
Practice Address - Street 2:STE 302
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606
Practice Address - Country:US
Practice Address - Phone:203-372-6505
Practice Address - Fax:203-372-5622
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2010-07-02
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Provider Licenses
StateLicense IDTaxonomies
CT0262072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D02732Medicare UPIN
CTC02084Medicare ID - Type Unspecified