Healthcare Provider Details

I. General information

NPI: 1659614337
Provider Name (Legal Business Name): TAMMI MARIE KRYSTAL PHILLIP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2013
Last Update Date: 08/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 YORK ST T-209, YALE-NEW HAVEN HOSPITAL
NEW HAVEN CT
06510-3220
US

IV. Provider business mailing address

P.O. BOX 207900
NEW HAVEN CT
06520-7990
US

V. Phone/Fax

Practice location:
  • Phone: 203-688-2259
  • Fax: 203-688-5599
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number54325
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number54325
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: