Healthcare Provider Details

I. General information

NPI: 1932345238
Provider Name (Legal Business Name): PATIENT FIRST MARYLAND MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 CRAIN HIGHWAY
WALDORF MD
20601
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 240-427-1926
  • Fax: 240-427-1927
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 NumberD0053640
License Number StateMD

VIII. Authorized Official

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