NPIMap

Organization Active NPI

Eastern Shore Pediatrics

  • Pediatrics Physician
  • Salisbury, MD
National Provider Identifier
1063713295
Registry record updated Nov 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
D50140 Issued in MD
Legal business name
EASTERN SHORE PEDIATRICS
Practice address
211 Maryland Ave
Salisbury, MD 21801-5805
Phone
(410) 219-9111
Fax
(410) 219-2633
NPI assigned
Nov 4, 2010
Last updated
Nov 25, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ephrem Daniel, MDNPI 1508849977
Title
Owner/President
Phone
(410) 219-9111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X D50140 MD Primary

Addresses

Primary practice location

211 Maryland Ave
Salisbury, MD 21801-5805

Mailing address

211 Maryland Ave
Salisbury, MD 21801-5805
Phone (410) 219-9111

Other identifiers 2

IdentifierTypeStateIssuer
559204600MedicaidMD
055501100MedicaidMD

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
21D2013640Eastern Shore Pediatrics, LLC211 Maryland Avenue, Salisbury, MD 21801Certificate of waiverSep 22, 2026

National Provider Directory

National Provider Directory

Locations

211 Maryland Ave
Salisbury, MD 21801
Phone (410) 219-9111

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1288828800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416873600000",
    "number": "1063713295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 MARYLAND AVE",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218015805",
            "telephone_number": "410-219-9111",
            "fax_number": "410-219-2633"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 MARYLAND AVE",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218015805",
            "telephone_number": "410-219-9111",
            "fax_number": "410-219-2633"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN SHORE PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-04",
        "last_updated": "2014-11-25",
        "status": "A",
        "authorized_official_last_name": "DANIEL",
        "authorized_official_first_name": "EPHREM",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "410-219-9111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MD",
            "license": "D50140",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "559204600",
            "state": "MD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "055501100",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salisbury, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.