Individual
JOHN KEITH PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4080 LAFAYETTE CENTER DR, SUITE 170, CHANTILLY, VA 20151-1247
(703) 766-5040
(703) 766-5047
Mailing address
PO BOX 791128, BALTIMORE, MD 21279-1128
(703) 391-2030
(703) 273-3943
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101231142
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05647398
—
VA
01
—
P00015942
RR MEDICARE
VA
Enumeration date
09/19/2005
Last updated
04/17/2012
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