Edyth Darlene Phillips, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

MD00009064 Issued in WA

Practice address

3200 78TH Ave. S.E.
Mercer Island, WA 98040

Phone

(206) 232-7218

Fax

(206) 232-8017

NPI assigned

Jul 14, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531440000000",
    "number": "1922024009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 2",
            "address_2": "3200 78TH AVE. S.E.",
            "city": "MERCER ISLAND",
            "state": "WA",
            "postal_code": "98040",
            "telephone_number": "206-232-7218",
            "fax_number": "206-232-8017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 78TH AVE. S.E.",
            "city": "MERCER ISLAND",
            "state": "WA",
            "postal_code": "98040",
            "telephone_number": "206-232-7218",
            "fax_number": "206-232-8017"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "EDYTH",
        "middle_name": "DARLENE",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-14",
        "last_updated": "2018-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "WA",
            "license": "MD00009064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1904309",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L & I",
            "identifier": "0102864",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles A Peterson, M.D.
• John Cleve Peterson III, M.D., M.P.H.
• Linda Peterson, MA/CCC SLP/AUD
• Alex Toan Pham
• Carter Ryan Phillips, PT, DPT
• Ryan Cory Phillips, RPH
• Dean Picozzi, MLP
• Ganga Pingili, PA
• Angel CHI CHI Planells, MS, RDN, FAND
• PNC Podiatry of Washington PLLC

• Psychiatry Physician in Mercer Island, WA
• Providers in Mercer Island, WA by specialty
• Psychiatry Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.