Healthcare Provider Details

I. General information

NPI: 1245484377
Provider Name (Legal Business Name): PATIENT FIRST MARYLAND MEDICAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 11/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7116 RITCHIE HIGHWAY
GLEN BURNIE MD
21061
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 443-577-0277
  • Fax: 443-577-0288
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 NumberD0047799
License Number StateMD

VIII. Authorized Official

Name: MR. MARVIN WARREN BRIDGERS III
Title or Position: DIRECTOR OF PHARMACY
Credential: R.PH.
Phone: 804-822-4383