Provider Demographics
NPI:1295705887
Name:PENINSULA ONCOLOGY AND HEMATOLOGY
Entity type:Organization
Organization Name:PENINSULA ONCOLOGY AND HEMATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-749-1282
Mailing Address - Street 1:145 E CARROLL ST
Mailing Address - Street 2:SUITE A-1
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5454
Mailing Address - Country:US
Mailing Address - Phone:410-749-1282
Mailing Address - Fax:410-749-7821
Practice Address - Street 1:145 E CARROLL ST
Practice Address - Street 2:SUITE A-1
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-5454
Practice Address - Country:US
Practice Address - Phone:410-749-1282
Practice Address - Fax:410-749-7821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========OtherTAX ID#
MDP87189Medicare UPIN
MDE46502Medicare UPIN
MDS939F680Medicare ID - Type Unspecified
MDS939Q350Medicare ID - Type Unspecified
MDC49215Medicare UPIN
S939Q349Medicare ID - Type Unspecified
MDD75300Medicare UPIN
MDS939Q351Medicare ID - Type Unspecified