Healthcare Provider Details

I. General information

NPI: 1699404202
Provider Name (Legal Business Name): AARON MICHAEL PHILLIPS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2022
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 CHALKSTONE AVE
PROVIDENCE RI
02908-4734
US

IV. Provider business mailing address

830 CHALKSTONE AVE
PROVIDENCE RI
02908-4734
US

V. Phone/Fax

Practice location:
  • Phone: 401-273-7100
  • Fax:
Mailing address:
  • Phone: 913-588-6412
  • Fax: 913-588-6414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0552093
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: