Healthcare Provider Details

I. General information

NPI: 1821502709
Provider Name (Legal Business Name): PHILLIP MICHAEL MORGAN M.S., PSYD CANDIDATE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1718 BELMONT AVE STE C
WINDSOR MILL MD
21244-2552
US

IV. Provider business mailing address

1718 BELMONT AVE STE C
WINDSOR MILL MD
21244-2552
US

V. Phone/Fax

Practice location:
  • Phone: 201-736-4811
  • Fax:
Mailing address:
  • Phone: 201-736-4811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number00000
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: