Healthcare Provider Details

I. General information

NPI: 1902246853
Provider Name (Legal Business Name): PATIENT FIRST PENNSYLVANIA MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 EAST GERMANTOWN PIKE
EAST NORRITON PA
19401
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 610-994-0063
  • Fax: 610-994-0064
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 NumberOS016503
License Number StatePA

VIII. Authorized Official

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