Healthcare Provider Details

I. General information

NPI: 1043756232
Provider Name (Legal Business Name): ATLANTIC GENERAL HOSPITAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12308 OCEAN GTWY STE 5
OCEAN CITY MD
21842-9341
US

IV. Provider business mailing address

10026 OLD OCEAN CITY BLVD BUILDING #1
BERLIN MD
21811-1288
US

V. Phone/Fax

Practice location:
  • Phone: 443-728-1090
  • Fax: 443-728-1091
Mailing address:
  • Phone: 410-629-6007
  • Fax: 410-641-9515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHERYL NOTTINGHAM
Title or Position: VP FINANCE/CFO
Credential:
Phone: 410-641-9602