Provider Demographics
NPI:1053349589
Name:PHILLIPS, SUZANNE L (DPM)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:L
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1073 SECOND STREET PIKE
Mailing Address - Street 2:
Mailing Address - City:RICHBORO
Mailing Address - State:PA
Mailing Address - Zip Code:18954-1803
Mailing Address - Country:US
Mailing Address - Phone:267-288-5103
Mailing Address - Fax:267-288-5108
Practice Address - Street 1:1073 SECOND STREET PIKE
Practice Address - Street 2:
Practice Address - City:RICHBORO
Practice Address - State:PA
Practice Address - Zip Code:18954-1803
Practice Address - Country:US
Practice Address - Phone:267-288-5103
Practice Address - Fax:267-288-5108
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005525213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU89990OtherHEALTH PARTNERS
PA1389267OtherHIGH MARK BLUE SHIELD
PA30080127OtherKEYSTONE MERCY , INDIVIDUAL PROVIDER NUMBER
6460450001Medicare NSC