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Organization

PREMIER PHYSICIAN GROUP, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MATTHEW G POFFENROTH (PRESIDENT / CEO)
(301) 896-6900
Entity
Organization

Contact information

Practice address
6430 ROCKLEDGE DRIVE, SUITE 470, BETHESDA, MD 20817
(301) 896-6931
(301) 581-0077
Mailing address
PO BOX 791372, BALTIMORE, MD 21279-1372
(301) 896-6931
(301) 581-0077

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
207Y00000X
Otolaryngology Physician
208600000X
Surgery Physician
Primary
208C00000X
Colon & Rectal Surgery Physician
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
208M00000X
Hospitalist Physician
231H00000X
Audiologist
363A00000X
Physician Assistant
363L00000X
Nurse Practitioner

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
415096100
MD
Enumeration date
02/13/2008
Last updated
11/13/2008
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