1336269620 NPI number — PHILIP A. PHILBIN, D.D.S., P.A.

Table of content: (NPI 1336269620)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336269620 NPI number — PHILIP A. PHILBIN, D.D.S., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHILIP A. PHILBIN, D.D.S., P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1336269620
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
226 LOOKOUT LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21409-6306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-757-1522
Provider Business Mailing Address Fax Number:
410-263-9722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 FORBES ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-1516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-263-5600
Provider Business Practice Location Address Fax Number:
410-263-9722
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PHILBIN
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
AUGUST
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-263-5600

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  09549 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1194874784 . This is a "NPI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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