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General NPI Number Information
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NPI Number | 1972939163
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Entity Type | Organization
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Legal Business Name | PATIENT FIRST MARYLAND MEDICAL GROUP
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Dates
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Enumeration Date | 09/19/2013
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Last Update Date | 09/19/2013
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Provider Practice Location Address
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Address Line | 8601 16TH ST
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City | SILVER SPRING
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State | MD
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Zip | 20910-2261
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Country | US
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Telephone | 301-960-4682
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Fax | 301-960-4683
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Provider Business Mailing Address
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Address Line | 5000 COX RD STE 100
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City | GLEN ALLEN
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State | VA
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Zip | 23060-9263
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Country | US
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Telephone | 804-822-4383
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Fax | 804-965-0987
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Authorized Official
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Title or Position | DIRECTOR OF PHARMACY
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Name | MR. MARVIN W BRIDGERS III
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Credential | RPH
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Telephone | 804-822-4383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | D0073254
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License Number State | MD
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