Provider Demographics
NPI:1396926242
Name:PENINSULA PLASTIC SURGERY P C
Entity type:Organization
Organization Name:PENINSULA PLASTIC SURGERY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:PERROTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-546-0464
Mailing Address - Street 1:314 W CARROLL ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5409
Mailing Address - Country:US
Mailing Address - Phone:410-546-0464
Mailing Address - Fax:410-546-8529
Practice Address - Street 1:30265 COMMERCE DR.
Practice Address - Street 2:SUITE 208
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966
Practice Address - Country:US
Practice Address - Phone:302-663-0119
Practice Address - Fax:302-663-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE1997115585174400000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00902Medicare Oscar/Certification
DEG00902Medicare Oscar/Certification
G00029Medicare PIN
DEG00029Medicare PIN