Healthcare Provider Details

I. General information

NPI: 1801614508
Provider Name (Legal Business Name): ATLANTIC GENERAL HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2024
Last Update Date: 05/30/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 ATLANTIC AVE STE 101
OCEAN VIEW DE
19970-9103
US

IV. Provider business mailing address

9733 HEALTHWAY DR
BERLIN MD
21811-1156
US

V. Phone/Fax

Practice location:
  • Phone: 302-541-4460
  • Fax:
Mailing address:
  • Phone: 410-629-6037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE GARY
Title or Position: SVP, FINANCE/CFO OF TIDALHEALTH
Credential:
Phone: 410-912-6059