Basic Information
Provider Information
NPI: 1104167238
EntityType: 2
ReplacementNPI:  
OrganizationName: PATIENT FIRST PENNSYLVANIA MEDICAL GROUP PLLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: PATIENT FIRST - EAST NORRITON
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5000 COX RD
Address2:  
City: GLEN ALLEN
State: VA
PostalCode: 230609263
CountryCode: US
TelephoneNumber: 8049685700
FaxNumber:  
Practice Location
Address1: 400 EAST GERMANTOWN PIKE
Address2:  
City: EAST NORRITON
State: PA
PostalCode: 194034228
CountryCode: US
TelephoneNumber: 6109940063
FaxNumber: 6109940064
Other Information
ProviderEnumerationDate: 03/14/2013
LastUpdateDate: 01/27/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: MORRISON
AuthorizedOfficialFirstName: GEORGE
AuthorizedOfficialMiddleName: H.
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 8049685700
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/27/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207Q00000X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansFamily Medicine 

ID Information
IDTypeStateIssuerDescription
DR672501PARAIL ROAD MEDICAREOTHER


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