=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619027729
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANDREW J PHILIPS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2007
-----------------------------------------------------
Last Update Date | 10/02/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | TWO BALA PLAZA SUITE IL35
-----------------------------------------------------
City | BALA CYNWYD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-667-6685
-----------------------------------------------------
Fax | 610-667-7909
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1135
-----------------------------------------------------
City | BALA CYNWYD
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-667-6685
-----------------------------------------------------
Fax | 610-667-7909
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | MD020841E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------