Provider Demographics
NPI:1124194956
Name:PENINSULA ORTHOPAEDIC ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:PENINSULA ORTHOPAEDIC ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRANDON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-749-4154
Mailing Address - Street 1:1675 WOODBROOKE DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-8502
Mailing Address - Country:US
Mailing Address - Phone:410-641-0202
Mailing Address - Fax:410-860-9583
Practice Address - Street 1:11107 CATHAGE RD UNIT 101
Practice Address - Street 2:
Practice Address - City:BERLIN
Practice Address - State:MD
Practice Address - Zip Code:21811-2155
Practice Address - Country:US
Practice Address - Phone:410-641-0202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5120610002Medicare NSC
MDH524Medicare PIN