Provider Demographics
NPI:1194954818
Name:JONATHAN D. PHILIPSON, M.D. & ASSOCIATES, LLC
Entity type:Organization
Organization Name:JONATHAN D. PHILIPSON, M.D. & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PHILIPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-236-9518
Mailing Address - Street 1:13 DIAMOND CREST CT
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1500
Mailing Address - Country:US
Mailing Address - Phone:410-236-9518
Mailing Address - Fax:410-653-0248
Practice Address - Street 1:13 DIAMOND CREST CT
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-1500
Practice Address - Country:US
Practice Address - Phone:410-236-9518
Practice Address - Fax:410-653-0248
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2009-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD36835207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty