Healthcare Provider Details

I. General information

NPI: 1710944848
Provider Name (Legal Business Name): ATLANTIC GENERAL HOSPITAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MARKET ST STE 101
POCOMOKE CITY MD
21851-1171
US

IV. Provider business mailing address

9733 HEALTHWAY DR
BERLIN MD
21811-1155
US

V. Phone/Fax

Practice location:
  • Phone: 410-957-1311
  • Fax: 410-957-1229
Mailing address:
  • Phone: 410-641-9602
  • Fax: 410-641-9670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number47-0120
License Number StateMD

VIII. Authorized Official

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