Healthcare Provider Details

I. General information

NPI: 1821382896
Provider Name (Legal Business Name): CAROL ANNE PHILLIPS, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SAINT PAUL ST SUITE 812
BALTIMORE MD
21202-2102
US

IV. Provider business mailing address

301 SAINT PAUL ST SUITE 812
BALTIMORE MD
21202-2102
US

V. Phone/Fax

Practice location:
  • Phone: 410-332-9878
  • Fax: 410-547-1805
Mailing address:
  • Phone: 410-332-9878
  • Fax: 410-547-1805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0047752
License Number StateMD

VIII. Authorized Official

Name: CAROL PHILLIPS
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 410-332-9878