Provider Demographics
NPI:1033157714
Name:SALZANO, RICHARD P JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:P
Last Name:SALZANO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:67 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-1328
Mailing Address - Country:US
Mailing Address - Phone:203-732-1330
Mailing Address - Fax:203-732-1332
Practice Address - Street 1:136 SHERMAN AVE STE 205
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5210
Practice Address - Country:US
Practice Address - Phone:203-732-1352
Practice Address - Fax:203-732-1525
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT034350208G00000X
CT34350174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1343508Medicaid
CT330000104Medicare ID - Type Unspecified
CTG02619Medicare UPIN