Healthcare Provider Details

I. General information

NPI: 1366113391
Provider Name (Legal Business Name): PATIENT FIRST MARYLAND MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13671 GEORGIA AVE
ASPEN HILL MD
20906-5214
US

IV. Provider business mailing address

5000 COX RD
GLEN ALLEN VA
23060-9263
US

V. Phone/Fax

Practice location:
  • Phone: 240-514-0000
  • Fax: 240-514-0001
Mailing address:
  • Phone: 804-822-4588
  • Fax: 804-965-0987

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: MR. ELWOOD PITTS JR.
Title or Position: PHARMACY MANAGER
Credential: CPHT
Phone: 804-822-4588