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General NPI Number Information
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NPI Number | 1336968619
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Entity Type | Organization
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Legal Business Name | TIDALHEALTH PENINSULA REGIONAL, INC.
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Dates
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Enumeration Date | 10/04/2024
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 100 E CARROLL ST
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City | SALISBURY
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State | MD
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Zip | 21801-5422
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Country | US
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Telephone | 410-543-4716
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 826880
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City | PHILADELPHIA
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State | PA
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Zip | 19182-6880
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Country | US
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Telephone | 410-543-7324
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT FINANCE
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Name | STEPHANIE GARY
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Credential |
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Telephone | 410-546-6400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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