Individual
DR. PHILIP LAURENCE MUSSENDEN SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1647 BENNING ROAD, N.E., SUITE 300B, WASHINGTON, DC 20002-4588
(202) 396-4774
(202) 396-8840
Mailing address
1647 BENNING ROAD, N.E., SUITE 300B, WASHINGTON, DC 20002-4588
(202) 396-4774
(202) 396-8840
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
MD25777
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005271000
MEDICAID
MD
05
—
022494800
—
DC
01
—
1871663200
FIRST HEALTH
—
01
—
4278
BLUE CROSS BLUE SHIELD
—
Enumeration date
11/02/2006
Last updated
01/07/2010
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