| South River Primary Care Llc | |
|
3168 Braverton St Suite 330 Edgewater MD 21037-2674 | |
| (410) 956-7830 | |
| (410) 956-7832 |
| Full Name | South River Primary Care Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3168 Braverton St, Edgewater, Maryland |
| Authorized Official Name and Position | Timothy Paul Fry (OWNER) |
| Authorized Official Contact | 4109567830 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South River Primary Care Llc 3168 Braverton St Suite 330 Edgewater MD 21037-2674 Ph: (410) 956-7830 | South River Primary Care Llc 3168 Braverton St Suite 330 Edgewater MD 21037-2674 Ph: (410) 956-7830 |
| NPI Number | 1154548303 |
|---|---|
| Provider Enumeration Date | 04/19/2007 |
| Last Update Date | 07/29/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154548303 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | H0056281 (Maryland) | Primary |
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