Healthcare Provider Details

I. General information

NPI: 1972558971
Provider Name (Legal Business Name): RETINA CONSULTANTS OF DELMARVA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 12/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6511 DEER POINTE DRIVE
SALISBURY MD
21804
US

IV. Provider business mailing address

6511 DEER POINTE DR
SALISBURY MD
21804-1667
US

V. Phone/Fax

Practice location:
  • Phone: 410-546-8037
  • Fax: 410-546-8038
Mailing address:
  • Phone: 410-546-8037
  • Fax: 410-546-8038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: LORI BROWN
Title or Position: OFFICE MANAGER
Credential:
Phone: 410-546-8037