Provider Demographics
NPI:1174786305
Name:PATIENT FIRST MARYLAND MEDICAL GROUP PLLC
Entity type:Organization
Organization Name:PATIENT FIRST MARYLAND MEDICAL GROUP PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIR OF PHARMCEUTICAL SERVICER
Authorized Official - Prefix:
Authorized Official - First Name:WARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRIDGERS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:804-822-4383
Mailing Address - Street 1:5000 COX RD
Mailing Address - Street 2:STE 100
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8105 RITCHIE HIGHWAY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122
Practice Address - Country:US
Practice Address - Phone:443-573-0564
Practice Address - Fax:443-573-0565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-08
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD000536403336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2134043OtherOTHER ID NUMBER