Healthcare Provider Details

I. General information

NPI: 1518399252
Provider Name (Legal Business Name): PENINSULA REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2013
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 S DIVISION ST
SALISBURY MD
21804-7291
US

IV. Provider business mailing address

100 E CARROLL ST
SALISBURY MD
21801-5422
US

V. Phone/Fax

Practice location:
  • Phone: 410-572-8848
  • Fax: 410-572-6890
Mailing address:
  • Phone: 410-543-7531
  • Fax: 410-912-6386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: DONNA E PALMER
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 410-543-7531