Provider Demographics
NPI:1801835145
Name:PHILLIPS, RONALD B (DO)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:B
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 1:2010 WEST CHESTER PIKE
Mailing Address - Street 2:SUITE 425
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083
Mailing Address - Country:US
Mailing Address - Phone:610-449-3265
Mailing Address - Fax:610-449-3262
Practice Address - Street 1:2010 WEST CHESTER PIKE
Practice Address - Street 2:SUITE 425
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083
Practice Address - Country:US
Practice Address - Phone:610-449-3265
Practice Address - Fax:610-449-3262
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002996L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD98665Medicare UPIN
PAPH116448Medicare ID - Type Unspecified