Provider Demographics
NPI:1952306060
Name:PHILLIPS, VAUL ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:VAUL
Middle Name:ANTHONY
Last Name:PHILLIPS
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 1:12150 ANNAPOLIS RD
Mailing Address - Street 2:STE 211
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9183
Mailing Address - Country:US
Mailing Address - Phone:202-369-3215
Mailing Address - Fax:
Practice Address - Street 1:12150 ANNAPOLIS RD
Practice Address - Street 2:STE 211
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9183
Practice Address - Country:US
Practice Address - Phone:202-369-3215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2016-05-06
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
DCMD20034208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC029888600Medicaid
DC029888600Medicaid
G00347Medicare UPIN