Provider Demographics
NPI:1972517522
Name:SIMON, PHILLIP NEAL (MD)
Entity type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:NEAL
Last Name:SIMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 POLARIS PKWY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8024
Mailing Address - Country:US
Mailing Address - Phone:614-865-4800
Mailing Address - Fax:614-865-4900
Practice Address - Street 1:110 POLARIS PKWY
Practice Address - Street 2:SUITE 250
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8024
Practice Address - Country:US
Practice Address - Phone:614-865-4800
Practice Address - Fax:614-865-4900
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35084614208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2545419Medicaid
OH4167431Medicare ID - Type Unspecified
OHI36741Medicare UPIN