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General NPI Number Information
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NPI Number | 1063713295
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Entity Type | Organization
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Legal Business Name | EASTERN SHORE PEDIATRICS
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Dates
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Enumeration Date | 11/04/2010
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 211 MARYLAND AVE
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City | SALISBURY
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State | MD
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Zip | 21801-5805
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Country | US
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Telephone | 410-219-9111
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Fax | 410-219-2633
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Provider Business Mailing Address
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Address Line | 211 MARYLAND AVE
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City | SALISBURY
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State | MD
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Zip | 21801-5805
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Country | US
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Telephone | 410-219-9111
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Fax | 410-219-2633
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. EPHREM DANIEL
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Credential | MD
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Telephone | 410-219-9111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | D50140
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License Number State | MD
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