Provider Demographics
NPI:1295820215
Name:HENJUM, PHILIP GOTTFRED (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:GOTTFRED
Last Name:HENJUM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18109 PRINCE PHILIP DR
Mailing Address - Street 2:SUITE #200
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1519
Mailing Address - Country:US
Mailing Address - Phone:301-774-7115
Mailing Address - Fax:301-570-6662
Practice Address - Street 1:18109 PRINCE PHILIP DR
Practice Address - Street 2:SUITE #200
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1519
Practice Address - Country:US
Practice Address - Phone:301-774-7115
Practice Address - Fax:301-570-6662
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2010-03-05
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Provider Licenses
StateLicense IDTaxonomies
MDD0035045207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE22206Medicare UPIN