Provider Demographics
NPI:1568455210
Name:GILDEN, PHILLIP (PT)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:
Last Name:GILDEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 FRANKLIN SQUARE DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-3936
Mailing Address - Country:US
Mailing Address - Phone:410-391-7908
Mailing Address - Fax:410-391-3491
Practice Address - Street 1:9101 FRANKLIN SQUARE DR
Practice Address - Street 2:SUITE 310
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-3936
Practice Address - Country:US
Practice Address - Phone:410-391-7908
Practice Address - Fax:410-391-3491
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2008-08-22
Deactivation Date:2005-08-30
Deactivation Code:
Reactivation Date:2005-09-16
Provider Licenses
StateLicense IDTaxonomies
MD14234174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD229LN327Medicare PIN
MDD12344Medicare UPIN