# SOUTH RIVER PRIMARY CARE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154548303
- **Authorized official:** DR. TIMOTHY PAUL FRY D.O. (OWNER)
- **Authorized official phone:** (410) 956-7830

## Contact information

- **Practice address:** 3168 BRAVERTON ST, SUITE 330, EDGEWATER, MD 21037-2674
- **Practice address phone:** (410) 956-7830
- **Practice address fax:** (410) 956-7832
- **Mailing address:** 3168 BRAVERTON ST, SUITE 330, EDGEWATER, MD 21037-2674
- **Mailing address phone:** (410) 956-7830
- **Mailing address fax:** (410) 956-7832

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | H0056281 | MD | Yes |

## Other

- **Enumeration date:** 04/19/2007
- **Last updated:** 07/29/2009