Provider Demographics
NPI:1003909896
Name:SALETTA, MICHAEL JOHN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOHN
Last Name:SALETTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325E KENNEDY MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4531
Mailing Address - Country:US
Mailing Address - Phone:207-872-2424
Mailing Address - Fax:207-872-2099
Practice Address - Street 1:325E KENNEDY MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4531
Practice Address - Country:US
Practice Address - Phone:207-872-2424
Practice Address - Fax:207-872-2099
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME013534207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME304090099Medicaid
ME006984OtherANTHEM
ME272270099Medicaid
E47985Medicare UPIN
MEMM486002Medicare PIN
ME272270099Medicaid
ME304090099Medicaid