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NPI Code Detail

MEDICARE: PENINSULA NEPHROLOGY ASSOCIATES, PA

MEDICARE: PENINSULA NEPHROLOGY ASSOCIATES, PA
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
1207RN0300XNephrology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811916976
Entity Type Code : Organization
Provider Name (Legal Business Name) : PENINSULA NEPHROLOGY ASSOCIATES, PA
Provider Business Mailing Address
First Line : 1821 SWEETBAY DR STE 1
Second Line :
City : SALISBURY
State : MD
Zip : 21804-1664
Country : US
Telephone Number : 410-546-4427
Fax Number : 443-736-4671
Provider Business Practice Location Address
First Line : 1821 SWEETBAY DR STE 1
Second Line :
City : SALISBURY
State : MD
Zip : 21804-1664
Country : US
Telephone Number : 410-546-4427
Fax Number : 443-736-4671
Authorized Official
Title or Position : PRACTICE ADMINISTRATOR
Name : TASIA POWERS
Credential :
Telephone Number : 410-546-4427
Provider Enumeration Date : 07/19/2006
Last Update Date : 06/03/2026

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