MEDICARE: DR. DOUGLAS R PHILLIPS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	130753	NY

General Provider Information

NPI Number	:	1649254004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS R PHILLIPS MD

Provider Business Mailing Address
First Line	:	375 E MAIN ST
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8418
Country	:	US
Telephone Number	:	631-646-1001
Fax Number	:	631-646-9803

Provider Business Practice Location Address
First Line	:	375 E MAIN ST
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8418
Country	:	US
Telephone Number	:	631-646-1001
Fax Number	:	631-646-9803

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	05/01/2026

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