Healthcare Provider Details

I. General information

NPI: 1063713295
Provider Name (Legal Business Name): EASTERN SHORE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2010
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 MARYLAND AVE
SALISBURY MD
21801-5805
US

IV. Provider business mailing address

211 MARYLAND AVE
SALISBURY MD
21801-5805
US

V. Phone/Fax

Practice location:
  • Phone: 410-219-9111
  • Fax: 410-219-2633
Mailing address:
  • Phone: 410-219-9111
  • Fax: 410-219-2633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD50140
License Number StateMD

VIII. Authorized Official

Name: DR. EPHREM DANIEL
Title or Position: OWNER/PRESIDENT
Credential: MD
Phone: 410-219-9111