MEDICARE: BRENDA M. PHILLIPS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	185388	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780633230
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRENDA M. PHILLIPS MD

Provider Business Mailing Address
First Line	:	154 PROSPECT AVE
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-1302
Country	:	US
Telephone Number	:	518-563-5440
Fax Number	:	518-563-1206

Provider Business Practice Location Address
First Line	:	154 PROSPECT AVE
Second Line	:
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-1302
Country	:	US
Telephone Number	:	518-563-5440
Fax Number	:	518-563-1206

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	01/28/2015

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