Provider Demographics
NPI:1922381748
Name:PATIENT FIRST MARYLAND MEDICAL GROUP
Entity Type:Organization
Organization Name:PATIENT FIRST MARYLAND MEDICAL GROUP
Other - Org Name:PATIENT FIRST CATONSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:MR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRIDGERS
Authorized Official - Suffix:III
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
Mailing Address - Country:US
Mailing Address - Phone:804-822-4383
Mailing Address - Fax:804-965-0987
Practice Address - Street 1:6333 BALTIMORE NATIONAL PIKE
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228
Practice Address - Country:US
Practice Address - Phone:443-514-1361
Practice Address - Fax:443-514-1362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053586332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site