Provider Demographics
NPI:1427134600
Name:PHILIPSON, JONATHAN DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DAVID
Last Name:PHILIPSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5820 YORK RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-3610
Mailing Address - Country:US
Mailing Address - Phone:410-433-0040
Mailing Address - Fax:410-630-1043
Practice Address - Street 1:5820 YORK RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3610
Practice Address - Country:US
Practice Address - Phone:410-433-0040
Practice Address - Fax:410-630-1043
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD36835207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD543401701Medicaid
MD034L440AMedicare PIN