Provider Demographics
NPI:1396808895
Name:PHILIP B. DVOSKIN M.D.P.A.
Entity type:Organization
Organization Name:PHILIP B. DVOSKIN M.D.P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:DVOSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-760-5588
Mailing Address - Street 1:1406B CRAIN HWY S
Mailing Address - Street 2:STE 301
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4099
Mailing Address - Country:US
Mailing Address - Phone:410-760-5588
Mailing Address - Fax:410-760-9727
Practice Address - Street 1:1406B CRAIN HWY S
Practice Address - Street 2:STE 301
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4099
Practice Address - Country:US
Practice Address - Phone:410-760-5588
Practice Address - Fax:410-760-9727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00030322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK077OtherCAREFIRST
MD21919OtherMAMSI
MDB70330Medicare UPIN
MD21919OtherMAMSI