Provider Demographics
NPI:1942271317
Name:ADELSON, PHILIP DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:DAVID
Last Name:ADELSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:P
Other - Middle Name:DAVID
Other - Last Name:ADELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3200 E CAMELBACK RD STE 250
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-2327
Mailing Address - Country:US
Mailing Address - Phone:602-933-1813
Mailing Address - Fax:
Practice Address - Street 1:1919 E THOMAS RD
Practice Address - Street 2:PHOENIX CHILDREN'S HOSPITAL, NEUROSURGERY DEPARTMENT
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7710
Practice Address - Country:US
Practice Address - Phone:602-933-0975
Practice Address - Fax:602-933-0445
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052592L174400000X
AZ41252207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001468700Medicaid
AZ398803Medicaid
PA409548FKCMedicare ID - Type Unspecified
AZ398803Medicaid