Healthcare Provider Details

I. General information

NPI: 1174786305
Provider Name (Legal Business Name): PATIENT FIRST MARYLAND MEDICAL GROUP PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 07/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8105 RITCHIE HIGHWAY
PASADENA MD
21122
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 443-573-0564
  • Fax: 443-573-0565
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number00053640
License Number StateMD

VIII. Authorized Official

Name: WARREN BRIDGERS
Title or Position: DIR OF PHARMCEUTICAL SERVICER
Credential: RPH
Phone: 804-822-4383