Provider Demographics
NPI:1346221686
Name:PHILIPS, PHILIP A (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:A
Last Name:PHILIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CUMBERLAND HILL RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:WOONSOCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02895-4854
Mailing Address - Country:US
Mailing Address - Phone:401-766-2970
Mailing Address - Fax:401-766-1523
Practice Address - Street 1:20 CUMBERLAND HILL RD
Practice Address - Street 2:SUITE 209
Practice Address - City:WOONSOCKET
Practice Address - State:RI
Practice Address - Zip Code:02895-4854
Practice Address - Country:US
Practice Address - Phone:401-766-2970
Practice Address - Fax:401-766-1523
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2011-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10158208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI0000002791OtherBLUE CROSS/BLUE SHIELD
RI9002791Medicaid
RI9002791Medicaid
RI007050077Medicare PIN