Provider Demographics
NPI:1528238557
Name:MCGANN, PHILIP J (MD)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:J
Last Name:MCGANN
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 1:1003 W 7TH ST
Mailing Address - Street 2:#400
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-8532
Mailing Address - Country:US
Mailing Address - Phone:301-662-3721
Mailing Address - Fax:301-631-5668
Practice Address - Street 1:1003 W 7TH ST
Practice Address - Street 2:SUITE 400
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-8532
Practice Address - Country:US
Practice Address - Phone:301-662-3721
Practice Address - Fax:301-631-5668
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0029921207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD463421700Medicaid
MDC57430Medicare UPIN
MD463421700Medicaid
MD5720Medicare PIN