Peter Malcolm Stanford, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

C04049 Issued in MD

Practice address

316 Railroad Ave
Goldsboro, MD 21636-1126

Phone

(410) 634-2380

Fax

(410) 482-7488

NPI assigned

Feb 2, 2013

Last updated

Oct 19, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Tidalhealth Peninsula Regional, Inc.

  • Family Medicine Physician
  • Salisbury, MD
  • NPI 1184832040
  Medicare reassignment NPD
• Tidalhealth Peninsula Regional, Inc.

  dba TidalHealth Specialty Pharmacy

  • Community/Retail Pharmacy
  • Salisbury, MD
  • NPI 1871031559
  NPD

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

{
    "created_epoch": "1359763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445212800000",
    "number": "1770822348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 RANDOLPH ST",
            "city": "DENTON",
            "state": "MD",
            "postal_code": "216291243",
            "telephone_number": "410-479-4306",
            "fax_number": "410-479-1714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "316 RAILROAD AVE",
            "city": "GOLDSBORO",
            "state": "MD",
            "postal_code": "216361126",
            "telephone_number": "410-634-2380",
            "fax_number": "410-482-7488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANFORD",
        "first_name": "PETER",
        "middle_name": "MALCOLM",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-02-02",
        "last_updated": "2015-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MD",
            "license": "C04049",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melinda Payton, CRNP
• Morgan Rhodes Smithmyer, DMD
• Jessica Mae Runkle, MS
• Senior Care of Goldsboro, Inc
• Shore Psychiatric Services LLC
• Barbara Louise Stanton, ARNP
• Trinity Alayna Sylvester
• Amanda Lynn Turner, RDH
• Yiya Zhou, D.D.S

• Medical Physician Assistant in Goldsboro, MD
• Providers in Goldsboro, MD by specialty
• Medical Physician Assistant in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.