Provider Demographics
NPI:1891738266
Name:PHILLIPS, REBECCA SUZANNE (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:SUZANNE
Last Name:PHILLIPS
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 1:85 BRYANT WOODS S
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-3604
Mailing Address - Country:US
Mailing Address - Phone:716-689-3333
Mailing Address - Fax:716-689-9866
Practice Address - Street 1:85 BRYANT WOODS S
Practice Address - Street 2:
Practice Address - City:AMHERST
Practice Address - State:NY
Practice Address - Zip Code:14228-3604
Practice Address - Country:US
Practice Address - Phone:716-689-3333
Practice Address - Fax:716-689-9866
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2385732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
00027642201OtherUNIVERA
000528591001OtherBC & BS WNY
571936OtherVALUE OPTIONS
1590807OtherINDEPENDENT HEALTH
000528591001OtherBC & BS WNY
RB0790Medicare ID - Type Unspecified