Healthcare Provider Details

I. General information

NPI: 1326039132
Provider Name (Legal Business Name): PENINSULA PULMONARY ASSOC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 EAST CARROLL ST PRMC STATION #379
SALISBURY MD
21801-5422
US

IV. Provider business mailing address

100 EAST CARROLL ST PRMC STATION #379
SALISBURY MD
21801-5422
US

V. Phone/Fax

Practice location:
  • Phone: 410-543-7722
  • Fax: 410-543-7725
Mailing address:
  • Phone: 410-543-7722
  • Fax: 410-543-7725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM J NAGEL
Title or Position: PRESIDENT
Credential: MD
Phone: 410-543-7722