Healthcare Provider Details

I. General information

NPI: 1548122096
Provider Name (Legal Business Name): PENINSUAL REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HALL HWY
CRISFIELD MD
21817-1237
US

IV. Provider business mailing address

PO BOX 826880
PHILADELPHIA PA
19182-6880
US

V. Phone/Fax

Practice location:
  • Phone: 410-543-4788
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SLOAN TRAMMELL
Title or Position: INSURANCE CREDENTIALING MANAGER
Credential:
Phone: 410-912-6989