Provider Demographics
NPI:1285996868
Name:ACQUAH, PHYLLIS VICTORIA (MD)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:VICTORIA
Last Name:ACQUAH
Suffix:
Gender:F
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:PO BOX 758963
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-8963
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:
Practice Address - Street 1:8206 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4519
Practice Address - Country:US
Practice Address - Phone:301-960-4682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT202228207Q00000X
MDD0079755207Q00000X
VA0101258342207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA522383YWAUMedicare PIN
MD522352YVZMedicare PIN
VAVVL985AMedicare PIN
MD522383YWV2Medicare PIN
MD522352ZDDBMedicare PIN