Provider Demographics
NPI:1366113425
Name:PRIORITY MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:PRIORITY MEDICAL GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:ABIMWO
Authorized Official - Last Name:GANG
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:301-408-8987
Mailing Address - Street 1:13000 BROOKMILL CT
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-2350
Mailing Address - Country:US
Mailing Address - Phone:301-408-8987
Mailing Address - Fax:
Practice Address - Street 1:13000 BROOKMILL CT
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-2350
Practice Address - Country:US
Practice Address - Phone:301-408-8987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care