Provider Demographics
NPI:1013422070
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:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LATOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
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:410-860-4506
Mailing Address - Fax:
Practice Address - Street 1:600 GLEN AVE UNIT 203
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-5250
Practice Address - Country:US
Practice Address - Phone:410-749-4154
Practice Address - Fax:410-749-4154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy