Provider Demographics
NPI:1639258536
Name:JAMES, PHYLLIS P (MD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:P
Last Name:JAMES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 BECKS WOODS DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-3851
Mailing Address - Country:US
Mailing Address - Phone:302-836-8200
Mailing Address - Fax:302-836-4302
Practice Address - Street 1:121 BECKS WOODS DR
Practice Address - Street 2:SUITE 100
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-3851
Practice Address - Country:US
Practice Address - Phone:302-836-8200
Practice Address - Fax:302-836-4302
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECI0003460207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001026402Medicaid
DE751802Medicare ID - Type Unspecified
DE0001026402Medicaid