| Trident Medical Group PA | |
|
10440 Little Patuxent Pkwy Ste 300 Columbia MD 21044-3648 | |
| (855) 770-7771 | |
| (415) 808-6405 |
| Full Name | Trident Medical Group PA |
|---|---|
| Speciality | Internal Medicine |
| Location | 10440 Little Patuxent Pkwy Ste 300, Columbia, Maryland |
| Authorized Official Name and Position | Devion Smith (DIRECTOR, PAYER CONTRACTING) |
| Authorized Official Contact | 4243268711 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Trident Medical Group PA 382 Ne 191st St Miami FL 33179-3899 Ph: (310) 626-0149 | Trident Medical Group PA 10440 Little Patuxent Pkwy Ste 300 Columbia MD 21044-3648 Ph: (855) 770-7771 |
| NPI Number | 1083368831 |
|---|---|
| Provider Enumeration Date | 02/10/2022 |
| Last Update Date | 11/14/2022 |
| Certification Date | 11/14/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083368831 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (NU) | Primary |
| 213EP0504X | Podiatrist - Public Medicine | (NU) | Secondary |
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