Provider Demographics
NPI:1316991961
Name:MUBARAK, PHILIP F (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:F
Last Name:MUBARAK
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 1:2113 ADAMS GRV
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-7102
Mailing Address - Country:US
Mailing Address - Phone:803-256-0531
Mailing Address - Fax:803-765-9052
Practice Address - Street 1:2113 ADAMS GRV
Practice Address - Street 2:SUITE 101
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-7102
Practice Address - Country:US
Practice Address - Phone:803-256-0531
Practice Address - Fax:803-765-9052
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12782208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC$$$$$$$$$OtherSSN
SC12782OtherSC STATE LIC #