Provider Demographics
NPI:1326039132
Name:PENINSULA PULMONARY ASSOC PA
Entity Type:Organization
Organization Name:PENINSULA PULMONARY ASSOC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:NAGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-543-7722
Mailing Address - Street 1:100 EAST CARROLL ST
Mailing Address - Street 2:PRMC STATION #379
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5422
Mailing Address - Country:US
Mailing Address - Phone:410-543-7722
Mailing Address - Fax:410-543-7725
Practice Address - Street 1:100 EAST CARROLL ST
Practice Address - Street 2:PRMC STATION #379
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5422
Practice Address - Country:US
Practice Address - Phone:410-543-7722
Practice Address - Fax:410-543-7725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
229675OtherMAMSI
CA8835OtherRAILROAD MEDICARE
DE0000631802OtherMEDICAL ASSISTANCE
1503877OtherUNITED MINE WORKERS
E601OtherBLUE SHIELD NATL CAPITAL
MDKU52PEOtherBLUE CROSS BLUE SHIELD
E601OtherBLUE SHIELD NATL CAPITAL