Provider Demographics
NPI:1912056243
Name:PENINSULA ALLERGY & ASTHMA ASSOCIATES P A
Entity Type:Organization
Organization Name:PENINSULA ALLERGY & ASTHMA ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CURT
Authorized Official - Middle Name:M
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-742-5599
Mailing Address - Street 1:201 PINE BLUFF ROAD
Mailing Address - Street 2:SUITE 28
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801
Mailing Address - Country:US
Mailing Address - Phone:410-742-5599
Mailing Address - Fax:410-742-4873
Practice Address - Street 1:201 PINE BLUFF ROAD
Practice Address - Street 2:SUITE 28
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:410-742-5599
Practice Address - Fax:410-742-4873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0050650207K00000X
DEC10005689207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD499106100Medicaid
DE1497999171OtherNPI
MDLX15PEOtherCAREFIRST BLUE CROSS
MDW4900002OtherBLUE CROSS NATIONAL
DE521164DELOtherBLUE CROSS DE
G98117OtherCURT WATKINS, UPIN
1194787689OtherCURT WATKINS NPI
DE1000001314Medicaid
G98117Medicare UPIN
DE1000001314Medicaid
MDW4900002OtherBLUE CROSS NATIONAL
DE1497999171OtherNPI
MD723LMedicare PIN