MEDICARE: PENINSULA REGIONAL MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1003058629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENINSULA REGIONAL MEDICAL CENTER

Provider Business Mailing Address
First Line	:	100 E CARROLL ST
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21801
Country	:	US
Telephone Number	:	410-543-7252
Fax Number	:	410-912-6386

Provider Business Practice Location Address
First Line	:	6295 TEAL LN
Second Line	:	ISLAND FAMILY MEDICINE
City	:	CHINCOTEAGUE
State	:	VA
Zip	:	23336-2207
Country	:	US
Telephone Number	:	757-336-2200
Fax Number	:	757-336-2211

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	DONNA E HORNER
Credential	:
Telephone Number	:	410-543-7531

Provider Enumeration Date	:	03/27/2009
Last Update Date	:	04/30/2009

Similar Medicare Providers

1205946779 — GLENN B. WOLFFE,M.D. P.C.
Practice Location Address:

6295 TEAL LN
CHINCOTEAGUE, VA
23336-2207

Practice Phone: 757-336-2200
Practice Fax: 757-336-2211

1164607602 — DR. RODEN C STEWART D.C.
Practice Location Address:

6295 TEAL LN
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Practice Phone: 757-336-7170
Practice Fax: 321-800-3383

1780164947 — ISLAND CHIROPRACTIC CENTER
Practice Location Address:

6295 TEAL LN
CHINCOTEAGUE ISLAND, VA
23336-2207

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Practice Fax:

1679430540 — JUSTIN WOLFE HORSCHEL USCG IDHS
Practice Location Address:

3823 MAIN ST
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23336-1857

Practice Phone: 254-423-2767
Practice Fax:

1104823624 — CHINCOTEAGUE VOLUNTEER FIRE CO
Practice Location Address:

4028 MAIN ST
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23336-2402

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1023003175 — H & H PHARMACY
Practice Location Address:

6300 MADDOX BLVD
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Practice Phone: 757-336-3115
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