Provider Demographics
NPI:1811913106
Name:PHUNG, PHILIPPE T (MD)
Entity type:Individual
Prefix:
First Name:PHILIPPE
Middle Name:T
Last Name:PHUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11510 GEORGIA AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1925
Mailing Address - Country:US
Mailing Address - Phone:301-946-5100
Mailing Address - Fax:301-929-0348
Practice Address - Street 1:110 IRVING ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2976
Practice Address - Country:US
Practice Address - Phone:301-946-5100
Practice Address - Fax:301-929-0348
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD30231207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC200120OtherKAISER
DC0081OtherCAREFIRST BCBS
DC5210298001OtherCIGNA HMO
VA5705002Medicaid
DC501344OtherNCPPO
DC5995593OtherAETNA NON HMO
DC2495297OtherAETNA HMO
VA441051OtherANTHEM BCBS
DC5210298001OtherCIGNA HMO
DC200120OtherKAISER