Peter Malcolm Stanford, PA-C
Individual provider Active NPI Medical Physician Assistant · Goldsboro, MD
NPI 1770822348 · NPPES record last updated Oct 19, 2015
Key facts
- NPI
- 1770822348
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- C04049 (MD)
- Practice address
- 316 Railroad Ave
Goldsboro, MD 21636-1126 - Phone
- (410) 634-2380
- Fax
- (410) 482-7488
- NPI assigned
- Feb 2, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MD
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151102001935 | MD | Practitioner - Physician Assistant | 6406166529 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001287 | IA | MD | Counseling Psychologist |
| C04049 | MD | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tidalhealth Peninsula Regional, Inc. | Current |
Accepting new patients | |
| Tidalhealth Peninsula Regional, Inc. | Current |
Accepting new patients |
Locations
145 E Carroll St
Salisbury, MD 21801
Phone (410) 546-6400
100 E Carroll St
Salisbury, MD 21801
Phone (410) 543-7100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | C04049 | MD | Yes |
Addresses
Primary practice location
316 Railroad Ave
Goldsboro, MD 21636-1126
Mailing address
301 Randolph St
Denton, MD 21629-1243
Phone (410) 479-4306
Other providers in Goldsboro, MD
- Melinda Payton
- Morgan Rhodes Smithmyer
- Jessica Mae Runkle
- Senior Care of Goldsboro, Inc
- Shore Psychiatric Services LLC
- Barbara Louise Stanton
- Trinity Alayna Sylvester
- Amanda Lynn Turner
- Yiya Zhou
All providers in Goldsboro, MD · Medical Physician Assistant in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 19, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.