Provider Demographics
NPI:1679598726
Name:PHILLIPS-COLE, BARBARA (MD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:PHILLIPS-COLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 880
Mailing Address - Street 2:
Mailing Address - City:SHELTER ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:11964-0880
Mailing Address - Country:US
Mailing Address - Phone:631-749-3149
Mailing Address - Fax:631-749-4257
Practice Address - Street 1:44 SOUTH FERRY ROAD
Practice Address - Street 2:
Practice Address - City:SHELTER ISLAND
Practice Address - State:NY
Practice Address - Zip Code:11964
Practice Address - Country:US
Practice Address - Phone:631-749-3149
Practice Address - Fax:631-749-4257
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2015-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272927-1207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03751026Medicaid
NY03751026Medicaid
LA1464155Medicaid
LAI04930Medicare UPIN
LA4F765Medicare ID - Type Unspecified