Provider Demographics
NPI:1194372870
Name:PATIENT FIRST MARYLAND MEDICAL GROUP
Entity Type:Organization
Organization Name:PATIENT FIRST MARYLAND MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELWOOD
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:804-822-4588
Mailing Address - Street 1:5000 COX RD STE 100
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-822-4588
Mailing Address - Fax:804-965-0987
Practice Address - Street 1:21044 FREDERICK RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4132
Practice Address - Country:US
Practice Address - Phone:240-238-5432
Practice Address - Fax:240-238-5433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-19
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site