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General NPI Number Information
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NPI Number | 1861698342
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Entity Type | Individual
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Provider Name | KASSANDRA JANE PHILLIPS D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 10/29/2020
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Provider Practice Location Address
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Address Line | 2937 FOX CHASE LN
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-4400
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Country | US
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Telephone | 804-372-3473
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Fax |
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Provider Business Mailing Address
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Address Line | 2937 FOX CHASE LN
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City | MIDLOTHIAN
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State | VA
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Zip | 23112-4400
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Country | US
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Telephone | 804-372-3473
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080I0007X
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Taxonomy Name | Pediatric Clinical & Laboratory Immunology Physician
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License Number | 2271
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 0102206067
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License Number State | VA
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