Healthcare Provider Details

I. General information

NPI: 1265722953
Provider Name (Legal Business Name): CHARLES ALLEN PHILLIPS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2011
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD DIVISIONS OF HEMATOLOGY AND ONCOLOGY
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

3401 CIVIC CENTER BLVD DIVISIONS OF HEMATOLOGY AND ONCOLOGY
PHILADELPHIA PA
19104-4319
US

V. Phone/Fax

Practice location:
  • Phone: 901-482-1772
  • Fax:
Mailing address:
  • Phone: 901-482-1772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberMT209862
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: