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General NPI Number Information
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NPI Number | 1790503464
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Entity Type | Organization
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Legal Business Name | ATLANTIC GENERAL HOSPITAL CORPORATION
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Dates
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Enumeration Date | 10/01/2024
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 38394 DUPONT BLVD STE H
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City | SELBYVILLE
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State | DE
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Zip | 19975-3049
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Country | US
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Telephone | 302-524-5007
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Fax | 302-524-5011
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Provider Business Mailing Address
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Address Line | 9733 HEALTHWAY DR
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City | BERLIN
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State | MD
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Zip | 21811-1156
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Country | US
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Telephone | 410-629-6037
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | JAMES KANUCH JR.
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Credential |
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Telephone | 410-641-9602
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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