Provider Demographics
NPI:1144844044
Name:PHILLIPS, WESLEY JAMES (MD)
Entity type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:JAMES
Last Name:PHILLIPS
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 1:496 W SHORE RD
Mailing Address - Street 2:
Mailing Address - City:HEBRON
Mailing Address - State:NH
Mailing Address - Zip Code:03241-7324
Mailing Address - Country:US
Mailing Address - Phone:410-710-9469
Mailing Address - Fax:
Practice Address - Street 1:101 BOULDER POINT DR STE 1
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264-3170
Practice Address - Country:US
Practice Address - Phone:603-536-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-05
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH23558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine