Provider Demographics
NPI:1245259308
Name:PENINSULA RENAL CARE
Entity type:Organization
Organization Name:PENINSULA RENAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CONSTANTE
Authorized Official - Middle Name:J
Authorized Official - Last Name:TAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-742-1800
Mailing Address - Street 1:1340 SOUTH DIVISION STREET
Mailing Address - Street 2:STE 302
Mailing Address - City:SALISBURY
Mailing Address - State:MO
Mailing Address - Zip Code:21804
Mailing Address - Country:US
Mailing Address - Phone:410-742-1800
Mailing Address - Fax:410-548-1288
Practice Address - Street 1:1340 SOUTH DIVISION STREET
Practice Address - Street 2:STE 302
Practice Address - City:SALISBURY
Practice Address - State:MO
Practice Address - Zip Code:21804
Practice Address - Country:US
Practice Address - Phone:410-742-1800
Practice Address - Fax:410-548-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment