Healthcare Provider Details

I. General information

NPI: 1861921397
Provider Name (Legal Business Name): ELLEN SARIDAKIS PHILLIPPI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 07/30/2020
Certification Date: 07/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 WATERDAM PLAZA DR
MC MURRAY PA
15317-2466
US

IV. Provider business mailing address

3600 FORBES AVE STE 140
PITTSBURGH PA
15213-3410
US

V. Phone/Fax

Practice location:
  • Phone: 724-969-1001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS020548
License Number StatePA

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: