Organization
SOUTH RIVER PRIMARY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY PAUL FRY D.O. (OWNER)
(410) 956-7830
Entity
Organization
Contact information
Practice address
3168 BRAVERTON ST, SUITE 330, EDGEWATER, MD 21037-2674
(410) 956-7830
(410) 956-7832
Mailing address
3168 BRAVERTON ST, SUITE 330, EDGEWATER, MD 21037-2674
(410) 956-7830
(410) 956-7832
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
H0056281
MD
Other
Enumeration date
04/19/2007
Last updated
07/29/2009
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