Provider Demographics
NPI:1649350653
Name:PHILIP, PRISCILLA (RPA-C)
Entity type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:
Last Name:PHILIP
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 PARKRIDGE CIR
Mailing Address - Street 2:APT 115
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2805
Mailing Address - Country:US
Mailing Address - Phone:215-964-1209
Mailing Address - Fax:
Practice Address - Street 1:1625 PARKRIDGE CIR
Practice Address - Street 2:APT 115
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-2805
Practice Address - Country:US
Practice Address - Phone:215-964-1209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012578363A00000X
TXPA07901363A00000X
MDC0004423363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant