Provider Demographics
NPI:1194748434
Name:DICKEY, PHILLIP S (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:S
Last Name:DICKEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1570 BOSTON POST RD STE 300
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2568
Mailing Address - Country:US
Mailing Address - Phone:203-772-4001
Mailing Address - Fax:203-772-4711
Practice Address - Street 1:1570 BOSTON POST RD STE 300
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2568
Practice Address - Country:US
Practice Address - Phone:203-772-4001
Practice Address - Fax:203-772-4711
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2022-11-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT027575207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001275751Medicaid