MEDICARE: PENINSULA ORTHOPAEDIC ASSOCIATES, P.A.

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	207X00000X	Orthopaedic Surgery Physician

General Provider Information

NPI Number	:	1326114141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PENINSULA ORTHOPAEDIC ASSOCIATES, P.A.

Provider Business Mailing Address
First Line	:	111 DAVIS STREET
Second Line	:	PO BOX 2415
City	:	SALISBURY
State	:	MD
Zip	:	21802-2415
Country	:	US
Telephone Number	:	410-749-4154
Fax Number	:	410-860-9583

Provider Business Practice Location Address
First Line	:	32033 BEAVER RUN DR
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21804-1773
Country	:	US
Telephone Number	:	410-749-4154
Fax Number	:	410-860-9583

Authorized Official
Title or Position	:	PRESIDENT AND CEO
Name	:	JOHN HOWARD HEDGER
Credential	:	M.D.
Telephone Number	:	410-749-4154

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	11/02/2007

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