Peninsula Plastic Surgery, P.C.

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

PENINSULA PLASTIC SURGERY, P.C.

Practice address

124 N Main St Ste D
Berlin, MD 21811-1060

Phone

(410) 546-0464

NPI assigned

Sep 10, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Vincent J Perrotta, MDNPI 1720033541

Title

Owner/President

Phone

(410) 546-0464

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Peninsula Plastic Surgery P.C.

  • Plastic Surgery Physician
  • Salisbury, MD
  • NPI 1598710485

  O20040702001135

  Same enrollment

Tax ID family

Peninsula Plastic Surgery P2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Peninsula Plastic Surgery, P.C.

  • Specialist
  • Georgetown, DE
  • NPI 1396991675
  NPD tax ID

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Vincent J Perrotta, M.D.

  • Plastic Surgery Physician
  • Salisbury, MD
  • NPI 1720033541
  NPD Authorized official
• Kerri Holloway, APRN

  • Family Nurse Practitioner
  • Salisbury, MD
  • NPI 1295272185
  NPD
• Thomas Kerestes, M.D.

  • Plastic Surgery Physician
  • Salisbury, MD
  • NPI 1922455484
  NPD
• Daniel Paul Luppens, M.D.

  • Plastic Surgery Physician
  • Richmond, VA
  • NPI 1124146501

  Plastic and Reconstructive Surgery

  NPD

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

{
    "created_epoch": "1536537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627862400000",
    "number": "1396228995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "314 W CARROLL ST STE 1",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218015409",
            "telephone_number": "410-546-0464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 N MAIN ST STE D",
            "city": "BERLIN",
            "state": "MD",
            "postal_code": "218111060",
            "telephone_number": "410-546-0464"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12308 Ocean Gtwy Ste 8",
            "address_purpose": "LOCATION",
            "city": "Ocean City",
            "state": "MD",
            "postal_code": "218429341",
            "country_code": "US",
            "telephone_number": "410-546-0464",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PENINSULA PLASTIC SURGERY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-09-10",
        "last_updated": "2021-08-02",
        "certification_date": "2021-08-02",
        "status": "A",
        "authorized_official_last_name": "PERROTTA",
        "authorized_official_first_name": "VINCENT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "410-546-0464",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Yvonne H. Payne, RN
• Katlynn Noel Peed
• Peninsual Regional Medical Center
• Peninsula Eye Center, P.a.
• Peninsula Orthopaedic Assoc PA
• Peninsula Regional Medical Center
• Amber K Penuel, PSY.D.
• Breea Pepiot
• Monica Lyn Perella, M.A.,SLP-
• Gordana Peric Stepcic, MD

• Specialist in Berlin, MD
• Providers in Berlin, MD by specialty
• Specialist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.