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NPI Code Detail

MEDICARE: PATIENT FIRST MARYLAND MEDICAL GROUP

MEDICARE: PATIENT FIRST MARYLAND MEDICAL GROUP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332900000XNon-Pharmacy Dispensing Site

General Provider Information

NPI Number : 1194372870
Entity Type Code : Organization
Provider Name (Legal Business Name) : PATIENT FIRST MARYLAND MEDICAL GROUP
Provider Business Mailing Address
First Line : 5000 COX RD STE 100
Second Line :
City : GLEN ALLEN
State : VA
Zip : 23060-9263
Country : US
Telephone Number : 804-822-4588
Fax Number : 804-965-0987
Provider Business Practice Location Address
First Line : 21044 FREDERICK RD
Second Line :
City : GERMANTOWN
State : MD
Zip : 20876-4132
Country : US
Telephone Number : 240-238-5432
Fax Number : 240-238-5433
Authorized Official
Title or Position : PHARMACY MANAGER
Name : ELWOOD PITTS JR.
Credential :
Telephone Number : 804-822-4588
Provider Enumeration Date : 08/19/2019
Last Update Date : 08/19/2019

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