Healthcare Provider Details

I. General information

NPI: 1982013694
Provider Name (Legal Business Name): JOHN MCPHILLIPS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 MALONEY RD
JOHNSTOWN NY
12095-3769
US

IV. Provider business mailing address

279 MALONEY RD
JOHNSTOWN NY
12095-3769
US

V. Phone/Fax

Practice location:
  • Phone: 518-736-2094
  • Fax: 518-736-1052
Mailing address:
  • Phone: 518-736-2094
  • Fax: 518-736-1052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number131979
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: