MEDICARE: PHILIP B BOVELL, MDPA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	D0020121	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104818582
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PHILIP B BOVELL, MDPA

Provider Business Mailing Address
First Line	:	11701 LIVINGSTON RD
Second Line	:	STE 204
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-5104
Country	:	US
Telephone Number	:	301-292-0757
Fax Number	:

Provider Business Practice Location Address
First Line	:	11701 LIVINGSTON RD
Second Line	:	STE 204
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-5104
Country	:	US
Telephone Number	:	301-292-0757
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. PHILIP BENJAMIN BOVELL
Credential	:	MD
Telephone Number	:	301-292-0757

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	01/23/2008

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