Provider Demographics
NPI:1598710485
Name:PENINSULA PLASTIC SURGERY P.C.
Entity Type:Organization
Organization Name:PENINSULA PLASTIC SURGERY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:PERROTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-546-0464
Mailing Address - Street 1:314 W CARROLL ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5305
Mailing Address - Country:US
Mailing Address - Phone:410-546-0464
Mailing Address - Fax:410-546-8529
Practice Address - Street 1:314 W CARROLL ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5305
Practice Address - Country:US
Practice Address - Phone:410-546-0464
Practice Address - Fax:410-546-8529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD567LMedicare ID - Type UnspecifiedMEDICARE