Provider Demographics
NPI:1508637182
Name:MY PRIMARY CARE
Entity Type:Organization
Organization Name:MY PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:APOLLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-604-4716
Mailing Address - Street 1:11901 EVENING CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1252
Mailing Address - Country:US
Mailing Address - Phone:410-751-7480
Mailing Address - Fax:
Practice Address - Street 1:533 JERMOR LN
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-6126
Practice Address - Country:US
Practice Address - Phone:410-751-7480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty