Provider Demographics
NPI:1245299858
Name:MOUNT, PHILIP M (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:M
Last Name:MOUNT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6 TREE FARM CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ARM
Mailing Address - State:MD
Mailing Address - Zip Code:21057-9110
Mailing Address - Country:US
Mailing Address - Phone:443-777-7202
Mailing Address - Fax:443-777-8237
Practice Address - Street 1:9000 FRANKLIN SQUARE DR
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-3901
Practice Address - Country:US
Practice Address - Phone:443-777-7197
Practice Address - Fax:443-777-8237
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0034081207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E37652Medicare UPIN