Healthcare Provider Details

I. General information

NPI: 1073522991
Provider Name (Legal Business Name): BARBARA LOUISE PHILLIPS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

574 MIDDLE TPKE E
MANCHESTER CT
06040-3730
US

IV. Provider business mailing address

574 MIDDLE TPKE E
MANCHESTER CT
06040-3730
US

V. Phone/Fax

Practice location:
  • Phone: 860-646-4334
  • Fax: 860-646-7020
Mailing address:
  • Phone: 860-646-4334
  • Fax: 860-646-7020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number042211
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: