1003058629 NPI number — PENINSULA REGIONAL MEDICAL CENTER

Table of content: (NPI 1003058629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003058629 NPI number — PENINSULA REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PENINSULA REGIONAL MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003058629
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6295 TEAL LN
Provider Second Line Business Practice Location Address:
ISLAND FAMILY MEDICINE
Provider Business Practice Location Address City Name:
CHINCOTEAGUE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23336-2207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-336-2200
Provider Business Practice Location Address Fax Number:
757-336-2211
Provider Enumeration Date:
03/27/2009

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com