Healthcare Provider Details

I. General information

NPI: 1922282425
Provider Name (Legal Business Name): 1ST MEDICAL OF ANNAPOLIS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2007
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MAYO RD STE 201
EDGEWATER MD
21037-1442
US

IV. Provider business mailing address

20 MAYO RD SUITE 201
EDGEWATER MD
21037-1439
US

V. Phone/Fax

Practice location:
  • Phone: 410-956-6800
  • Fax: 410-956-6803
Mailing address:
  • Phone: 410-956-6800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROSEMARY INGADO
Title or Position: CLINICAL ADMINISTRATOR/PHYSICIAN AS
Credential: PA
Phone: 410-956-6800