Healthcare Provider Details

I. General information

NPI: 1194372870
Provider Name (Legal Business Name): PATIENT FIRST MARYLAND MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 08/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21044 FREDERICK RD
GERMANTOWN MD
20876-4132
US

IV. Provider business mailing address

5000 COX RD STE 100
GLEN ALLEN VA
23060-9263
US

V. Phone/Fax

Practice location:
  • Phone: 240-238-5432
  • Fax: 240-238-5433
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: ELWOOD PITTS JR.
Title or Position: PHARMACY MANAGER
Credential:
Phone: 804-822-4588