Healthcare Provider Details

I. General information

NPI: 1225232374
Provider Name (Legal Business Name): CALMAN PHILIP PRUSSIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 ROCKVILLE PIKE BUILDING 10, ROOM 11C207, NATIONAL INSTITUTES OF HEALTH
BETHESDA MD
20892-1881
US

IV. Provider business mailing address

11608 DANVILLE DR
ROCKVILLE MD
20852-3716
US

V. Phone/Fax

Practice location:
  • Phone: 301-496-1306
  • Fax: 301-496-1306
Mailing address:
  • Phone: 301-770-2553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number917278
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: