Provider Demographics
NPI:1871566935
Name:PENINSULA NEUROSURGICAL ASSOCIATES PA
Entity type:Organization
Organization Name:PENINSULA NEUROSURGICAL ASSOCIATES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES PENINSULA NEUROSURGICAL ASSOC
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIUS
Authorized Official - Middle Name:D
Authorized Official - Last Name:ZANT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-860-0084
Mailing Address - Street 1:540 SNOW HILL RD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6031
Mailing Address - Country:US
Mailing Address - Phone:410-860-0084
Mailing Address - Fax:410-860-0411
Practice Address - Street 1:540 SNOW HILL RD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6031
Practice Address - Country:US
Practice Address - Phone:410-860-0084
Practice Address - Fax:410-860-0411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD083601000Medicaid
MD6226120001Medicare NSC