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Organization
TIDALHEALTH PENINSULA REGIONAL, INC.
Active
Organization
TIDALHEALTH PENINSULA REGIONAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE GARY (CFO)
(410) 912-6059
Entity
Organization
Contact information
Practice address
100 E CARROLL ST, PENINSULA REGIONAL MEDICAL GROUP, SALISBURY, MD 21801-5422
(410) 543-7252
(410) 912-6386
Mailing address
100 E CARROLL ST, PENINSULA REGIONAL MEDICAL GROUP, SALISBURY, MD 21801-5422
(410) 543-7252
(410) 912-6386
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
NULL
207P00000X
Emergency Medicine Physician
—
—
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
NULL
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
—
207RG0100X
Gastroenterology Physician
—
NULL
207RG0100X
Gastroenterology Physician
—
—
207RH0003X
Hematology & Oncology Physician
—
NULL
207RH0003X
Hematology & Oncology Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
NULL
207RP1001X
Pulmonary Disease Physician
—
—
207T00000X
Neurological Surgery Physician
—
NULL
207T00000X
Neurological Surgery Physician
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
208D00000X
General Practice Physician
—
NULL
208D00000X
General Practice Physician
—
—
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
NULL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
NULL
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
NULL
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
05/21/2007
Last updated
02/28/2023
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