Healthcare Provider Details

I. General information

NPI: 1790979136
Provider Name (Legal Business Name): GREEN SPRING PATIENT FIRST SERIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 EASTERN AVENUE
BALTIMORE MD
21224
US

IV. Provider business mailing address

5000 COX RD SUITE 100 PATIENT FIRST
GLEN ALLEN VA
23060
US

V. Phone/Fax

Practice location:
  • Phone: 410-814-4500
  • Fax:
Mailing address:
  • Phone: 804-822-4383
  • 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. MARVIN WARREN BRIDGERS III
Title or Position: DIRECTOR OF PHARMACY SERVICES
Credential: RPH
Phone: 804-822-4383