Provider Demographics
NPI:1659495554
Name:HIGGINS, PHILLIP L
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:L
Last Name:HIGGINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 ACCOKEEK RD W
Mailing Address - Street 2:
Mailing Address - City:ACCOKEEK
Mailing Address - State:MD
Mailing Address - Zip Code:20607-2300
Mailing Address - Country:US
Mailing Address - Phone:301-399-1066
Mailing Address - Fax:
Practice Address - Street 1:2000 ACCOKEEK RD W
Practice Address - Street 2:
Practice Address - City:ACCOKEEK
Practice Address - State:MD
Practice Address - Zip Code:20607-2300
Practice Address - Country:US
Practice Address - Phone:301-399-1066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCWMATC 1256343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)