MEDICARE: DR. PHILLIP H OMOHUNDRO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	MD13399	DC
2	207X00000X	Orthopaedic Surgery Physician	D25458	MD
3	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	D0025458	MD
4	207X00000X	Orthopaedic Surgery Physician	MD13399	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871553594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHILLIP H OMOHUNDRO M.D.

Provider Business Mailing Address
First Line	:	12200 ANNAPOLIS RD STE 123
Second Line	:
City	:	GLENN DALE
State	:	MD
Zip	:	20769-9182
Country	:	US
Telephone Number	:	301-364-9292
Fax Number	:	855-291-3304

Provider Business Practice Location Address
First Line	:	12200 ANNAPOLIS RD STE 123
Second Line	:
City	:	GLENN DALE
State	:	MD
Zip	:	20769-9182
Country	:	US
Telephone Number	:	301-364-9292
Fax Number	:	855-291-3304

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	01/08/2024

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Directions to “ DR. PHILLIP H OMOHUNDRO M.D.” Practice Location

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