Provider Demographics
NPI:1841755048
Name:RUSSELL E PHILLIPS MD LLC
Entity Type:Organization
Organization Name:RUSSELL E PHILLIPS MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:E
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-986-5710
Mailing Address - Street 1:100 E LANCASTER AVE STE 415
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3439
Mailing Address - Country:US
Mailing Address - Phone:610-896-5710
Mailing Address - Fax:610-896-1667
Practice Address - Street 1:100 E LANCASTER AVE STE 415
Practice Address - Street 2:
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3439
Practice Address - Country:US
Practice Address - Phone:610-896-5710
Practice Address - Fax:610-896-1667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-01
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty