Provider Demographics
NPI:1124297486
Name:PHILIP, MARYZABETH (OD)
Entity type:Individual
Prefix:
First Name:MARYZABETH
Middle Name:
Last Name:PHILIP
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 19091
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21284-9091
Mailing Address - Country:US
Mailing Address - Phone:410-579-8347
Mailing Address - Fax:
Practice Address - Street 1:7081 ARUNDEL MILLS CIR
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-1387
Practice Address - Country:US
Practice Address - Phone:410-579-8347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2015-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA2054152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist