Healthcare Provider Details

I. General information

NPI: 1962742817
Provider Name (Legal Business Name): JANET MARIE TALLEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1630 WOODBROOKE DR
SALISBURY MD
21804-8501
US

IV. Provider business mailing address

100 E CARROLL ST
SALISBURY MD
21801-5422
US

V. Phone/Fax

Practice location:
  • Phone: 410-546-6400
  • Fax:
Mailing address:
  • Phone: 410-543-7531
  • Fax: 410-912-4972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0004981
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: