Provider Demographics
NPI:1639142391
Name:PHILLIPS, ERIC CHRISTOPHER (DO)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:CHRISTOPHER
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GUTHRIE SQ
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-1625
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:31 ARNOT RD
Practice Address - Street 2:
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845
Practice Address - Country:US
Practice Address - Phone:607-795-5100
Practice Address - Fax:607-739-3632
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC39799207Q00000X
NY192934207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012957160004Medicaid
NY01431630Medicaid
NY080174242OtherRR MEDICARE PIN
NYCC8362OtherRR MEDICARE GROUP
SC192934Medicaid
NYCC8362OtherRR MEDICARE GROUP
NY080174242OtherRR MEDICARE PIN