Healthcare Provider Details

I. General information

NPI: 1154308021
Provider Name (Legal Business Name): EASTERN SHORE ENT & ALLERGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MILFORD ST SUITE 101
SALISBURY MD
21804-6953
US

IV. Provider business mailing address

106 MILFORD ST SUITE 101
SALISBURY MD
21804-6953
US

V. Phone/Fax

Practice location:
  • Phone: 410-742-1908
  • Fax:
Mailing address:
  • Phone: 410-742-1908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL LEE ONEAL
Title or Position: BILLING
Credential:
Phone: 410-742-1567