Healthcare Provider Details

I. General information

NPI: 1740286699
Provider Name (Legal Business Name): PHILLIP V MCALLISTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 10/01/2020
Certification Date: 10/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 MYRTLE ST STE L90
ERIE PA
16502-4607
US

IV. Provider business mailing address

2315 MYRTLE ST STE L90
ERIE PA
16502-4607
US

V. Phone/Fax

Practice location:
  • Phone: 814-452-7575
  • Fax: 814-452-7574
Mailing address:
  • Phone: 814-452-7575
  • Fax: 814-452-7574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberMD471375
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: