# PENINSULA REGIONAL MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Laurel Family Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083856686
- **Authorized official:** DONNA E HORNER (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (410) 543-7531

## Contact information

- **Practice address:** 30668 SUSSEX HWY, LAUREL FAMILY MEDICINE, LAUREL, DE 19956-4421
- **Practice address phone:** (302) 875-6550
- **Practice address fax:** (302) 875-6573
- **Mailing address:** 100 E CARROLL ST, SALISBURY, MD 21801-5422
- **Mailing address phone:** (410) 543-7252
- **Mailing address fax:** (410) 912-6386

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/27/2009
- **Last updated:** 04/30/2009