MEDICARE: PATIENT FIRST MARYLAND MEDICAL GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332900000X	Non-Pharmacy Dispensing Site

General Provider Information

NPI Number	:	1366113391
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATIENT FIRST MARYLAND MEDICAL GROUP

Provider Business Mailing Address
First Line	:	5000 COX RD
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-9263
Country	:	US
Telephone Number	:	804-822-4588
Fax Number	:	804-965-0987

Provider Business Practice Location Address
First Line	:	13671 GEORGIA AVE
Second Line	:
City	:	ASPEN HILL
State	:	MD
Zip	:	20906-5214
Country	:	US
Telephone Number	:	240-514-0000
Fax Number	:	240-514-0001

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	MR. ELWOOD PITTS JR.
Credential	:	CPHT
Telephone Number	:	804-822-4588

Provider Enumeration Date	:	09/21/2021
Last Update Date	:	09/21/2021

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