NPIMap

Organization Active NPI

Peninsula Surgical Group, P.a.

  • Surgery Physician
  • Salisbury, MD
National Provider Identifier
1962484428
Registry record updated Dec 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
PENINSULA SURGICAL GROUP, P.A.
Practice address
145 E Carroll St
Salisbury, MD 21801-5454
Phone
(410) 548-2600
Fax
(410) 548-2607
NPI assigned
Nov 18, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2011

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

Authorized official

Name
John A Bartkovich, MD
Title
Owner
Phone
(410) 548-2600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

145 E Carroll St
Salisbury, MD 21801-5454

Mailing address

PO Box 3317
Salisbury, MD 21802-3317
Phone (410) 548-2600

Other identifiers 1

IdentifierTypeStateIssuer
978541800MedicaidMD

National Provider Directory

National Provider Directory

Locations

145 E Carroll St
Ste 202B
Salisbury, MD 21801

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1132272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323388800000",
    "number": "1962484428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3317",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218023317",
            "telephone_number": "410-548-2600",
            "fax_number": "410-548-2607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 E CARROLL ST",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218015454",
            "telephone_number": "410-548-2600",
            "fax_number": "410-548-2607"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENINSULA SURGICAL GROUP, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-18",
        "last_updated": "2011-12-09",
        "status": "A",
        "authorized_official_last_name": "BARTKOVICH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-548-2600",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "978541800",
            "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 Dec 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.