Provider Demographics
NPI:1114956711
Name:EASTERN SHORE PHYSICIANS & SURGEONS,INC
Entity Type:Organization
Organization Name:EASTERN SHORE PHYSICIANS & SURGEONS,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:DUER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-442-6600
Mailing Address - Street 1:PO BOX 77
Mailing Address - Street 2:
Mailing Address - City:NASSAWADOX
Mailing Address - State:VA
Mailing Address - Zip Code:23413-0077
Mailing Address - Country:US
Mailing Address - Phone:757-442-6600
Mailing Address - Fax:
Practice Address - Street 1:9524 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:NASSAWADOX
Practice Address - State:VA
Practice Address - Zip Code:23413
Practice Address - Country:US
Practice Address - Phone:757-442-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0352160001Medicare NSC
VAC01632Medicare PIN