1922381748 NPI number — PATIENT FIRST MARYLAND MEDICAL GROUP

Table of content: JILL MARIE SULLIVAN PHYSICAL THERAPIST (NPI 1780755405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922381748 NPI number — PATIENT FIRST MARYLAND MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATIENT FIRST MARYLAND MEDICAL GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1922381748
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 COX RD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
GLEN ALLEN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-822-4383
Provider Business Mailing Address Fax Number:
804-965-0987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6333 BALTIMORE NATIONAL PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CATONSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-514-1361
Provider Business Practice Location Address Fax Number:
443-514-1362
Provider Enumeration Date:
09/28/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BRIDGERS
Authorized Official First Name:
MARVIN
Authorized Official Middle Name:
W
Authorized Official Title or Position:
DIRECTOR OF PHARMACY
Authorized Official Telephone Number:
804-822-4383

Provider Taxonomy Codes

  • Taxonomy code: 332900000X , with the licence number:  D0053586 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com