Provider Demographics
NPI:1871685339
Name:PROCTOR, PHILIP J (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:J
Last Name:PROCTOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7500 GREENWAY CENTER DR FL 8
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3502
Mailing Address - Country:US
Mailing Address - Phone:301-477-2000
Mailing Address - Fax:301-474-2389
Practice Address - Street 1:7500 GREENWAY CENTER DR FL 8
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3502
Practice Address - Country:US
Practice Address - Phone:301-477-2000
Practice Address - Fax:301-474-2389
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0068043208800000X
DC16941208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC011265700Medicaid
DC011265700Medicaid
DC721762Medicare ID - Type Unspecified