Individual
MARY JACOB PHILIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
600 N WOLFE ST, BALTIMORE, MD 21287-0005
(410) 955-5000
Mailing address
9910 FRANKLIN SQUARE DR STE 2110, BALTIMORE, MD 21236-4902
(410) 933-6421
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
D83050
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D83050
LICENSE
MD
Enumeration date
05/15/2012
Last updated
12/19/2018
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