Provider Demographics
NPI:1376664060
Name:SALAN, SANDRA LEE ZUCKER (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:LEE ZUCKER
Last Name:SALAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:13464 HOLLY SPRING DR
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-2329
Mailing Address - Country:US
Mailing Address - Phone:301-843-1868
Mailing Address - Fax:301-374-9742
Practice Address - Street 1:13464 HOLLY SPRING DR
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2329
Practice Address - Country:US
Practice Address - Phone:301-843-1868
Practice Address - Fax:301-374-9742
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00161572084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology