Provider Demographics
NPI:1922213107
Name:PHILLIPS, PAUL M (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2591 WEXFORD BAYNE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SEWICKLEY
Mailing Address - State:PA
Mailing Address - Zip Code:15143-8676
Mailing Address - Country:US
Mailing Address - Phone:724-933-5588
Mailing Address - Fax:
Practice Address - Street 1:2591 WEXFORD BAYNE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-8676
Practice Address - Country:US
Practice Address - Phone:724-933-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD434452207W00000X
VA0101243413207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology