Provider Demographics
NPI:1114062064
Name:C. G. SALAME M.D. L.L.C.
Entity Type:Organization
Organization Name:C. G. SALAME M.D. L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CAMILLE
Authorized Official - Middle Name:G
Authorized Official - Last Name:SALAME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-889-8598
Mailing Address - Street 1:ONE TOWNE PARK PLZ
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360
Mailing Address - Country:US
Mailing Address - Phone:860-889-8598
Mailing Address - Fax:860-889-8598
Practice Address - Street 1:ONE TOWNE PARK PLZ
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2247
Practice Address - Country:US
Practice Address - Phone:860-889-8598
Practice Address - Fax:860-889-8598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032052207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001320522Medicaid
CT001320522Medicaid
CT140000123Medicare PIN