Healthcare Provider Details

I. General information

NPI: 1073061842
Provider Name (Legal Business Name): DELMARVA KIDNEY & HYPERTENSION SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2016
Last Update Date: 02/16/2023
Certification Date: 02/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 RIVERSIDE DR STE A203
SALISBURY MD
21801-4704
US

IV. Provider business mailing address

560 RIVERSIDE DR STE A203
SALISBURY MD
21801-4704
US

V. Phone/Fax

Practice location:
  • Phone: 443-978-7319
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ERIC OFORI
Title or Position: OWNER
Credential: MD
Phone: 347-432-7032