Healthcare Provider Details

I. General information

NPI: 1952732851
Provider Name (Legal Business Name): PATIENT FIRST MARYLAND MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2013
Last Update Date: 12/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 YORK RD
TOWSON MD
21204-2513
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 410-372-6373
  • Fax: 410-372-6374
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 NumberD0061289
License Number StateMD

VIII. Authorized Official

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