Healthcare Provider Details

I. General information

NPI: 1184630543
Provider Name (Legal Business Name): PETER C PHILLIPS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD CHCA HEMATOLOGY & ONCOLOGY
PHILADELPHIA PA
19104-4319
US

IV. Provider business mailing address

100 E PENN SQ FL 9 CHCA HEMATOLOGY & ONCOLOGY
PHILADELPHIA PA
19107-3377
US

V. Phone/Fax

Practice location:
  • Phone: 215-590-3535
  • Fax: 215-590-3992
Mailing address:
  • Phone: 267-425-9232
  • Fax: 267-425-9299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberMD043817L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number142163
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: