| Lower Shore Clinic, Inc. | |
|
505 E Main St Salisbury MD 21804 | |
| (410) 341-3420 | |
| (410) 341-3397 |
| Full Name | Lower Shore Clinic, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 505 E Main St, Salisbury, Maryland |
| Authorized Official Name and Position | Kristine Gartlitz (CLINIC DIRECTOR) |
| Authorized Official Contact | 4103413420 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lower Shore Clinic, Inc. 716 N Division St Salisbury MD 21801-4156 Ph: (410) 341-3420 | Lower Shore Clinic, Inc. 505 E Main St Salisbury MD 21804 Ph: (410) 341-3420 |
| NPI Number | 1154320646 |
|---|---|
| Provider Enumeration Date | 07/18/2005 |
| Last Update Date | 09/25/2019 |
| Medicare PECOS PAC ID | 2365469947 |
|---|---|
| Medicare Enrollment ID | O20051102000426 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154320646 | NPI | - | NPPES |
| LS92 | Other | MD | BLUE CROSS BLUE SHIELD MD |
| 298470900 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (Maryland) | Primary |
| Provider Name | Efigenio Bautista |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1427032705 PECOS PAC ID: 2860388014 Enrollment ID: I20040224001265 |
| Provider Name | Shashikala Venkatachalapathy |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1669555462 PECOS PAC ID: 3577665207 Enrollment ID: I20070226000736 |
| Provider Name | Helen F Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255495511 PECOS PAC ID: 0749453165 Enrollment ID: I20111101000059 |
| Provider Name | Kristine Garlitz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1356608137 PECOS PAC ID: 9335301654 Enrollment ID: I20120503000210 |
| Provider Name | Jeannette Kathleen Buchanan |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1164773248 PECOS PAC ID: 2062667231 Enrollment ID: I20160408000692 |
| Provider Name | Keesha L Holden White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750834800 PECOS PAC ID: 9032406285 Enrollment ID: I20161003000733 |
| Provider Name | Kristine Hickman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629515812 PECOS PAC ID: 3870879588 Enrollment ID: I20170412001627 |
| Provider Name | Kelly M Beeseck |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1750840203 PECOS PAC ID: 6406181023 Enrollment ID: I20190718000457 |
| Provider Name | Rachel Z Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255728648 PECOS PAC ID: 8325379480 Enrollment ID: I20191004000214 |
| Provider Name | Michele Y Mcintosh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578104899 PECOS PAC ID: 2264866573 Enrollment ID: I20191219001164 |
| Provider Name | Staci L Butler |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215545116 PECOS PAC ID: 9537585740 Enrollment ID: I20200819000953 |
| Provider Name | Deepa Abhilash |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831718972 PECOS PAC ID: 7214356880 Enrollment ID: I20200930003381 |
| Provider Name | Melissa A Wiley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609522556 PECOS PAC ID: 0749675650 Enrollment ID: I20220310002919 |
| Provider Name | Chelsea Renee Pantalone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649915489 PECOS PAC ID: 3779960307 Enrollment ID: I20220519001439 |
| Provider Name | Lindsey Weller |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1073007910 PECOS PAC ID: 4688045016 Enrollment ID: I20230124000033 |
| Provider Name | Tamara M Dougherty |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1164790663 PECOS PAC ID: 5991154916 Enrollment ID: I20231215000029 |
| Provider Name | Teresa Beath |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1255908711 PECOS PAC ID: 3173973484 Enrollment ID: I20231229000027 |
| Provider Name | Christianna Bull |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1477306603 PECOS PAC ID: 6103265608 Enrollment ID: I20240417000580 |
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