Provider Demographics
NPI:1871581975
Name:MCPHILLIPS, SUSAN JANE (MD)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:JANE
Last Name:MCPHILLIPS
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 1:100 PARK ST
Mailing Address - Street 2:GLENS FALLS HOSPITAL
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4413
Mailing Address - Country:US
Mailing Address - Phone:518-926-7100
Mailing Address - Fax:518-926-7069
Practice Address - Street 1:1 LAWRENCE ST
Practice Address - Street 2:CENTER FOR CHILDREN AND FAMILIES
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-3617
Practice Address - Country:US
Practice Address - Phone:518-926-7100
Practice Address - Fax:518-926-7069
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1325892084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00033406OtherRR MEDICARE
NYDD0289Medicare PIN
F70201Medicare UPIN
NYDD6479Medicare PIN