Healthcare Provider Details

I. General information

NPI: 1568429538
Provider Name (Legal Business Name): CHILDREN'S MEDICAL GROUP OF SALISBURY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 PHILLIP MORRIS DR
SALISBURY MD
21804-1923
US

IV. Provider business mailing address

217 PHILLIP MORRIS DR
SALISBURY MD
21804-1923
US

V. Phone/Fax

Practice location:
  • Phone: 410-546-3173
  • Fax: 410-742-4804
Mailing address:
  • Phone: 410-546-3173
  • Fax: 410-742-4804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM W CLENDENEN
Title or Position: CO-OWNER
Credential: D.O.
Phone: 410-546-3173