Provider Demographics
NPI:1790216026
Name:PHILIP, NESSA SARAH (MD)
Entity type:Individual
Prefix:
First Name:NESSA
Middle Name:SARAH
Last Name:PHILIP
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 1:201 E I30 STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-5402
Mailing Address - Country:US
Mailing Address - Phone:972-772-3100
Mailing Address - Fax:469-757-4890
Practice Address - Street 1:201 E I30 STE 100
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-5402
Practice Address - Country:US
Practice Address - Phone:972-772-3100
Practice Address - Fax:469-757-4890
Is Sole Proprietor?:No
Enumeration Date:2017-03-27
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS3568208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics