# MEDEXPRESS PRIMARY CARE MARYLAND, P.C.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sephora - Belcamp
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962049114
- **Authorized official:** BRETT GALL (DIRECTOR PAYOR CONTRACTING)
- **Authorized official phone:** (304) 225-2500

## Contact information

- **Practice address:** 4622 MERCEDES DR, BELCAMP, MD 21017-1223
- **Practice address phone:** (410) 297-2452
- **Practice address fax:** (410) 297-2453
- **Mailing address:** 1001 CONSOL ENERGY DR, CANONSBURG, PA 15317-6506
- **Mailing address phone:** (304) 225-2500
- **Mailing address fax:** (724) 743-1133

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/06/2019
- **Last updated:** 12/18/2019