Provider Demographics
NPI:1295910792
Name:PRIMARY CARE PHYSICIANS LLC
Entity type:Organization
Organization Name:PRIMARY CARE PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-218-3884
Mailing Address - Street 1:2905 MITCHELLVILLE RD
Mailing Address - Street 2:SUITE104
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1385
Mailing Address - Country:US
Mailing Address - Phone:301-218-3884
Mailing Address - Fax:301-218-3886
Practice Address - Street 1:2905 MITCHELLVILLE RD
Practice Address - Street 2:SUITE104
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1385
Practice Address - Country:US
Practice Address - Phone:301-218-3884
Practice Address - Fax:301-218-3886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD41240207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD341201600Medicaid
MDG00772Medicare PIN
MD341201600Medicaid