Healthcare Provider Details

I. General information

NPI: 1740219674
Provider Name (Legal Business Name): ERROL A PHILLIP MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 05/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 MEDICAL PKWY SUITE 670
ANNAPOLIS MD
21401-3046
US

IV. Provider business mailing address

PO BOX 64713
BALTIMORE MD
21264-4713
US

V. Phone/Fax

Practice location:
  • Phone: 410-481-1150
  • Fax: 410-224-0065
Mailing address:
  • Phone: 443-481-6538
  • Fax: 443-481-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0009453
License Number StateMD

VIII. Authorized Official

Name: DR. ERROL A PHILLIP
Title or Position: OWNER
Credential: M.D.
Phone: 443-481-1150