Provider Demographics
NPI:1922282425
Name:1ST MEDICAL OF ANNAPOLIS, INC.
Entity Type:Organization
Organization Name:1ST MEDICAL OF ANNAPOLIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL ADMINISTRATOR/PHYSICIAN AS
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:INGADO
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:410-956-6800
Mailing Address - Street 1:20 MAYO RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037-1439
Mailing Address - Country:US
Mailing Address - Phone:410-956-6800
Mailing Address - Fax:
Practice Address - Street 1:20 MAYO RD STE 201
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:MD
Practice Address - Zip Code:21037-1442
Practice Address - Country:US
Practice Address - Phone:410-956-6800
Practice Address - Fax:410-956-6803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2022-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD516301300Medicaid