Provider Demographics
NPI:1306843784
Name:SALM, JENNIFER MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MARIE
Last Name:SALM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:50 MEMORIAL BLVD
Mailing Address - Street 2:AQUIDNECK MEDICAL ASSOCIATES, INC
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02840-3587
Mailing Address - Country:US
Mailing Address - Phone:401-847-2290
Mailing Address - Fax:401-849-8446
Practice Address - Street 1:50 MEMORIAL BLVD
Practice Address - Street 2:AQUIDNECK MEDICAL ASSOCIATES, INC
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-3587
Practice Address - Country:US
Practice Address - Phone:401-847-2290
Practice Address - Fax:401-849-8446
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10578208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIJS35938Medicaid
RIJS35938Medicaid
RI007008884Medicare PIN