Healthcare Provider Details

I. General information

NPI: 1740292788
Provider Name (Legal Business Name): JULIE MCCOLE PHILLIPS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 HOLLAND AVE
ALBANY NY
12208-3410
US

IV. Provider business mailing address

113 HOLLAND AVE
ALBANY NY
12208-3410
US

V. Phone/Fax

Practice location:
  • Phone: 518-626-6047
  • Fax:
Mailing address:
  • Phone: 518-626-6093
  • Fax: 518-626-6045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number235935
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: