1023445939 NPI number — DR. CARLOS WILLIAM PHILLIP ED.D.

Table of content: DR. CARLOS WILLIAM PHILLIP ED.D. (NPI 1023445939)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023445939 NPI number — DR. CARLOS WILLIAM PHILLIP ED.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PHILLIP
Provider First Name:
CARLOS
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
ED.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023445939
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9312 OGDEN PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANHAM
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20706-2774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-938-1175
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 55TH STREET NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON DC
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-939-2030
Provider Business Practice Location Address Fax Number:
240-485-0995
Provider Enumeration Date:
10/09/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TS0200X , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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