Provider Demographics
NPI:1881761518
Name:PHILLIPS, ANTHONY E (LIC AC)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:E
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-2767
Mailing Address - Country:US
Mailing Address - Phone:781-643-2614
Mailing Address - Fax:
Practice Address - Street 1:140 COMMONWEALTH AVE STE 210
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3625
Practice Address - Country:US
Practice Address - Phone:978-531-7470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202430171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist