Healthcare Provider Details

I. General information

NPI: 1912145707
Provider Name (Legal Business Name): PHILLIP SHERMAN RAGLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 WILKENS AVE STE 100
BALTIMORE MD
21229-5204
US

IV. Provider business mailing address

215 NAVAJO DR
RED LION PA
17356-9646
US

V. Phone/Fax

Practice location:
  • Phone: 240-447-8036
  • Fax: 240-213-2335
Mailing address:
  • Phone: 202-270-7542
  • Fax: 240-213-2335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberMD0068492
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD036446
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD0068492
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD0068492
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: