Provider Demographics
NPI:1306938295
Name:PHILLIPS, USHA K (MD)
Entity type:Individual
Prefix:DR
First Name:USHA
Middle Name:K
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4401 E LOHMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8267
Mailing Address - Country:US
Mailing Address - Phone:575-532-9077
Mailing Address - Fax:575-532-9221
Practice Address - Street 1:4371 E LOHMAN AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8255
Practice Address - Country:US
Practice Address - Phone:575-532-8900
Practice Address - Fax:575-532-8910
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD2015-0072208000000X
NJMA06648200207K00000X
PAMD450127208000000X
NJ25MA066482002080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7790601Medicaid
NJ7790601Medicaid