Provider Demographics
NPI:1568429538
Name:CHILDREN'S MEDICAL GROUP OF SALISBURY, PA
Entity Type:Organization
Organization Name:CHILDREN'S MEDICAL GROUP OF SALISBURY, PA
Other - Org Name:AGARWAL,CLENDENEN, AND ASSOCIATES, PA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:W
Authorized Official - Last Name:CLENDENEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:410-546-3173
Mailing Address - Street 1:217 PHILLIP MORRIS DR
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-1923
Mailing Address - Country:US
Mailing Address - Phone:410-546-3173
Mailing Address - Fax:410-742-4804
Practice Address - Street 1:217 PHILLIP MORRIS DR
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-1923
Practice Address - Country:US
Practice Address - Phone:410-546-3173
Practice Address - Fax:410-742-4804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty