Healthcare Provider Details

I. General information

NPI: 1144744707
Provider Name (Legal Business Name): PATIENT FIRST MARYLAND MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 ANNAPOLIS ROAD
LANDOVER HILLS MD
20784
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 301-276-3377
  • Fax: 301-276-3378
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. MARVIN WARREN BRIDGERS III
Title or Position: VP, PHARMACY
Credential: RPH
Phone: 804-822-4383