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NPI Code Detail

MEDICARE: BLUE HERON MEDICAL GROUP LLC

MEDICARE: BLUE HERON MEDICAL GROUP LLC
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
1207Q00000XFamily Medicine PhysicianD058928MD
2207Q00000XFamily Medicine PhysicianD45995MD
3207R00000XInternal Medicine PhysicianD24871MD
4207R00000XInternal Medicine PhysicianD36576MD
5363LF0000XFamily Nurse PractitionerQ37875MD
6207R00000XInternal Medicine PhysicianD24872MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11841384625OTHERMDNPI
21245292853OTHERMDNPI
31639269368OTHERMDNPI
41265491286OTHERMDNPI
51669558227OTHERMDNPI
61992764815OTHERMDNPI

General Provider Information

NPI Number : 1861686313
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUE HERON MEDICAL GROUP LLC
Provider Business Mailing Address
First Line : 305 10TH ST
Second Line : STE 101
City : POCOMOKE CITY
State : MD
Zip : 21851-1607
Country : US
Telephone Number : 410-957-3005
Fax Number : 410-957-0550
Provider Business Practice Location Address
First Line : 305 10TH ST
Second Line : STE 101
City : POCOMOKE CITY
State : MD
Zip : 21851-1607
Country : US
Telephone Number : 410-957-3005
Fax Number : 410-957-0550
Authorized Official
Title or Position : DOCTOR
Name : DR. PAUL REARDON FLEURY
Credential : M.D.
Telephone Number : 410-957-3005
Provider Enumeration Date : 08/28/2007
Last Update Date : 03/01/2012

Similar Medicare Providers

1578566790 — MR. JUAN CARLOS ZELAYA PA-C
Practice Location Address:
305 10TH ST STE 104
POCOMOKE CITY, MD
21851-1607
Practice Phone: 410-957-0273
Practice Fax: 410-957-0152
1265491286 — PAUL R FLEURY M.D.
Practice Location Address:
305 10TH ST , SUITE 101
POCOMOKE, MD
21851-1607
Practice Phone: 410-957-3005
Practice Fax: 410-957-0550
1992764815 — MARY L FLEURY M.D.
Practice Location Address:
305 10TH ST , SUITE 101
POCOMOKE, MD
21851-1607
Practice Phone: 410-957-3005
Practice Fax: 410-957-0550
1245292853 — AMY S. JOHNSON M.D.
Practice Location Address:
305 10TH ST , SUITE 101
POCOMOKE, MD
21851-1607
Practice Phone: 410-957-3005
Practice Fax: 410-957-0550
1730278508 — MS. SHEILA ANN KERPELMAN CRNP
Practice Location Address:
305 10TH ST STE 104
POCOMOKE CITY, MD
21851-1607
Practice Phone: 410-957-0273
Practice Fax: 410-957-0152
1164641437 — SALISBURY PHYSICAL THERAPY & SPORTSMEDICINE
Practice Location Address:
305 10TH ST , SUITE 102
POCOMOKE CITY, MD
21851-1607
Practice Phone: 410-543-9000
Practice Fax: 410-543-9033

Directions to “BLUE HERON MEDICAL GROUP LLC ” Practice Location

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