Healthcare Provider Details

I. General information

NPI: 1902809858
Provider Name (Legal Business Name): PENINSULA CARDIOLOGY ASSOCIATES, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 EASTERN SHORE DR
SALISBURY MD
21804-5565
US

IV. Provider business mailing address

PO BOX 49
SALISBURY MD
21803-0049
US

V. Phone/Fax

Practice location:
  • Phone: 410-749-8906
  • Fax: 410-219-5662
Mailing address:
  • Phone: 410-749-8906
  • Fax: 410-219-5662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number StateMD
# 6
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number StateMD
# 7
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOANNA M ANDERSON
Title or Position: BILLING MANAGER
Credential: CPC
Phone: 410-749-0821