MEDICARE: DR. COURTNEY K PHILLIPS M.D.

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	208800000X	Urology Physician	223589	NY
2	208800000X	Urology Physician	MD465048	PA

General Provider Information

NPI Number	:	1780626754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COURTNEY K PHILLIPS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 783311
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-3311
Country	:	US
Telephone Number	:	484-884-4500
Fax Number	:	484-884-0699

Provider Business Practice Location Address
First Line	:	1250 S CEDAR CREST BLVD STE 215
Second Line	:
City	:	ALLENTOWN
State	:	PA
Zip	:	18103-6271
Country	:	US
Telephone Number	:	610-402-6986
Fax Number	:	610-402-4460

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	10/12/2018

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