Provider Demographics
NPI:1285639336
Name:SALVATERRA, CARMEN (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:
Last Name:SALVATERRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 WYMAN PARK DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2803
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10724 LITTLE PATUXENT PKWY
Practice Address - Street 2:STE 200
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3106
Practice Address - Country:US
Practice Address - Phone:410-997-5944
Practice Address - Fax:410-997-1720
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0033627207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB69729Medicare UPIN
MD264YMedicare ID - Type Unspecified