Healthcare Provider Details

I. General information

NPI: 1275694630
Provider Name (Legal Business Name): CAROLYN ANN PHILLIPS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WASHINGTON HOSPITAL CENTER DEPT OF EMERGENCY MEDICINE 110 IRVING ST NW
WASHINGTON DC
20010
US

IV. Provider business mailing address

WASHINGTON HOSPITAL CENTER DEPT OF EMERGENCY MEDICINE 110 IRVING ST NW
WASHINGTON DC
20010
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-9696
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMT182913
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD427178
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD036552
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: