Provider Demographics
NPI:1801194709
Name:PNJ PRIMARY CARE LLC
Entity type:Organization
Organization Name:PNJ PRIMARY CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:THOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-682-8888
Mailing Address - Street 1:5100 BUCKEYSTOWN PIKE STE 186
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-8337
Mailing Address - Country:US
Mailing Address - Phone:301-682-8888
Mailing Address - Fax:301-682-3515
Practice Address - Street 1:5100 BUCKEYSTOWN PIKE STE 186
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-8337
Practice Address - Country:US
Practice Address - Phone:301-682-8888
Practice Address - Fax:301-682-3515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QE0002X, 208D00000X
MDD00286640261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD481191700Medicaid
MD481191700Medicaid
MDH745I361Medicare PIN