Basic Information
| Provider Information | |||||||||
| NPI: | 1194372870 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PATIENT FIRST MARYLAND MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 COX RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | GLEN ALLEN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230609263 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048224588 | ||||||||
| FaxNumber: | 8049650987 | ||||||||
| Practice Location | |||||||||
| Address1: | 21044 FREDERICK RD | ||||||||
| Address2: | |||||||||
| City: | GERMANTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208764132 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2402385432 | ||||||||
| FaxNumber: | 2402385433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2019 | ||||||||
| LastUpdateDate: | 08/19/2019 | ||||||||
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| AuthorizedOfficialLastName: | PITTS | ||||||||
| AuthorizedOfficialFirstName: | ELWOOD | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHARMACY MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8048224588 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332900000X | Y | Suppliers | Non-Pharmacy Dispensing Site |
No ID Information.