Healthcare Provider Details

I. General information

NPI: 1871688341
Provider Name (Legal Business Name): DERWIN A PHILLIP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 FRANKLIN SQUARE DRIVE
BALTIMORE MD
21237
US

IV. Provider business mailing address

1000 RIVER ROAD STE 100
CONSHOHOCKEN PA
19428
US

V. Phone/Fax

Practice location:
  • Phone: 877-202-9696
  • Fax:
Mailing address:
  • Phone: 800-355-3818
  • Fax: 610-834-2862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberXXXXXX
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036139796
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: