Healthcare Provider Details

I. General information

NPI: 1982925640
Provider Name (Legal Business Name): SHORE HEALTH SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 06/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9507 HOSPITAL AVENUE
NASSAWADOX VA
23413-0736
US

IV. Provider business mailing address

PO BOX 736
NASSAWADOX VA
23413-0736
US

V. Phone/Fax

Practice location:
  • Phone: 757-414-8054
  • Fax: 757-414-8055
Mailing address:
  • Phone: 757-414-8054
  • Fax: 757-414-8055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH P ZAGER
Title or Position: VP
Credential:
Phone: 757-414-8000