Basic Information
| Provider Information | |||||||||
| NPI: | 1831198829 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PHILLIP | ||||||||
| FirstName: | ERROL | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 12622 | ||||||||
| Address2: | |||||||||
| City: | BELFAST | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049154017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4434816560 | ||||||||
| FaxNumber: | 4434816515 | ||||||||
| Practice Location | |||||||||
| Address1: | 1419 FOREST DR | ||||||||
| Address2: | |||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214031482 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109900050 | ||||||||
| FaxNumber: | 4109900336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2005 | ||||||||
| LastUpdateDate: | 08/24/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | D0009453 | MD | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100045 | 01 | AETNA HMO | OTHER | 121071800 | 05 | MD | MEDICAID | 4069881 | 01 | AETNA PPO | OTHER | 6531185 | 01 | MD | AETNA HMO | OTHER | 267081 | 01 | MAMSI | OTHER | 05256 | 01 | AMERIGROUP | OTHER | 147736500 | 01 | FEDERAL WORKMANS COMP | OTHER | 34655005 | 01 | BCBS | OTHER | 34655005 | 01 | MD | BCBS | OTHER | 0001 | 01 | BCBS | OTHER | X602-0001 | 01 | DC | BCBS | OTHER |