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Mary Jacob Philip

Radiology

Allopathic & Osteopathic Physicians

600 N Wolfe St, Baltimore, MD 21287-0005

PECOS Enrollment

This provider is enrolled in PECOS as MARY PHILIP.

Based on the most recent information from CMS, provider Mary Jacob Philip is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1225397995
Provider Type
Individual
Full Name
Philip, Mary Jacob
Credential
MD

Gender
Female
Sole Proprietor
No
Enumeration Date
5/15/2012
Last Updated
12/19/2018

Contact Information

Practice Location

600 N Wolfe St, Baltimore, MD 21287-0005

(410) 955-5000

Unlisted Fax

Mailing Location

9910 Franklin Square Dr Ste 2110, Baltimore, MD 21236-4902

(410) 933-6421

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 2085R0202X Primary	Description Radiology Allopathic & Osteopathic Physicians	License D83050 Maryland

Provider Identifiers

ID	Description	Issuer
ID D83050	Description Other	Issuer LICENSE Maryland

Mary Jacob Philip

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Wang, Kenneth C.

Halsey, Neal

Facciola, James Joseph

Gujar, Sachin K

Montano, Maria

Hawasli, Hazem

Haviazheu, Dzmitry

Scott, William

D'Angelo, Michael Wayne

Lurito, Joseph T