South River Primary Care LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

H0056281 Issued in MD

Legal business name

SOUTH RIVER PRIMARY CARE LLC

Practice address

3168 Braverton St
Suite 330
Edgewater, MD 21037-2674

Phone

(410) 956-7830

Fax

(410) 956-7832

NPI assigned

Apr 19, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Timothy Paul Fry, D.O.NPI 1326082439

Title

Owner

Phone

(410) 956-7830

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Timothy Paul Fry, D.O.

  • Family Medicine Physician
  • Annapolis, MD
  • NPI 1326082439
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248825600000",
    "number": "1154548303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3168 BRAVERTON ST",
            "address_2": "SUITE 330",
            "city": "EDGEWATER",
            "state": "MD",
            "postal_code": "210372674",
            "telephone_number": "410-956-7830",
            "fax_number": "410-956-7832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3168 BRAVERTON ST",
            "address_2": "SUITE 330",
            "city": "EDGEWATER",
            "state": "MD",
            "postal_code": "210372674",
            "telephone_number": "410-956-7830",
            "fax_number": "410-956-7832"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTH RIVER PRIMARY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-19",
        "last_updated": "2009-07-29",
        "status": "A",
        "authorized_official_last_name": "FRY",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-956-7830",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "H0056281",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sol & Luna Wellness LLC
• South River Ambulatory Surgery
• South River Family Chiropractic LLC
• South River Internal Medicine, PA
• South River Nursing and Rehab Center LLC
• Alexa Spearman
• Jessica Lynne Stallings, CRNP-PMH, PMHNP-BC
• Statcare Group LLC
• Destinie Janerio Statum, LMSW
• Anne Ross Stewart, D. MIN., LCPC, LCMFT

• Family Medicine Physician in Edgewater, MD
• Providers in Edgewater, MD by specialty
• Family Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.