Provider Demographics
NPI:1821502709
Name:MORGAN, PHILLIP MICHAEL (MS, PSYD CANDIDATE)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:MICHAEL
Last Name:MORGAN
Suffix:
Gender:M
Credentials:MS, PSYD CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1718 BELMONT AVE STE C
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2552
Mailing Address - Country:US
Mailing Address - Phone:201-736-4811
Mailing Address - Fax:
Practice Address - Street 1:1718 BELMONT AVE STE C
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2552
Practice Address - Country:US
Practice Address - Phone:201-736-4811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA00000207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine