Provider Demographics
NPI:1518152420
Name:SALM, MARTIN ERNST (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:ERNST
Last Name:SALM
Suffix:
Gender:M
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:PO BOX 5910
Mailing Address - Street 2:
Mailing Address - City:STATELINE
Mailing Address - State:NV
Mailing Address - Zip Code:89449-5910
Mailing Address - Country:US
Mailing Address - Phone:775-588-5000
Mailing Address - Fax:775-588-5001
Practice Address - Street 1:276 KINGSBURY GRADE, SUITE 101
Practice Address - Street 2:
Practice Address - City:STATELINE
Practice Address - State:NV
Practice Address - Zip Code:89449-5910
Practice Address - Country:US
Practice Address - Phone:775-588-5000
Practice Address - Fax:775-588-5001
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6357207N00000X, 207ND0101X, 207ND0900X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVV102229Medicare PIN