Provider Demographics
NPI:1457384265
Name:SPENCER D PHILLIPS MD MDVIP LTD
Entity Type:Organization
Organization Name:SPENCER D PHILLIPS MD MDVIP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:D
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-517-7841
Mailing Address - Street 1:2113 MANOR RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17603-4215
Mailing Address - Country:US
Mailing Address - Phone:717-517-7841
Mailing Address - Fax:717-517-7853
Practice Address - Street 1:2113 MANOR RIDGE DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17603-4215
Practice Address - Country:US
Practice Address - Phone:717-517-7841
Practice Address - Fax:717-517-7853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2022-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA741701Medicare PIN