Provider Demographics
NPI:1912145707
Name:RAGLAND, PHILLIP SHERMAN (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:SHERMAN
Last Name:RAGLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 NAVAJO DR
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-9646
Mailing Address - Country:US
Mailing Address - Phone:202-270-7542
Mailing Address - Fax:240-213-2335
Practice Address - Street 1:3455 WILKENS AVE STE 100
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5204
Practice Address - Country:US
Practice Address - Phone:240-447-8036
Practice Address - Fax:240-213-2335
Is Sole Proprietor?:No
Enumeration Date:2009-02-02
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD0068492207QA0401X, 208600000X, 208D00000X
MDMD036446208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1912145707OtherNPI
MD963103OtherCAREFIRST
MD176785ZA46Medicare PIN