Provider Demographics
NPI:1629199450
Name:SALAZAR, LEOPLOLDO (MD)
Entity Type:Individual
Prefix:
First Name:LEOPLOLDO
Middle Name:
Last Name:SALAZAR
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 1:703 MILLDAM RD
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-1430
Mailing Address - Country:US
Mailing Address - Phone:410-828-7758
Mailing Address - Fax:410-828-6373
Practice Address - Street 1:98 N BROADWAY
Practice Address - Street 2:SUITE 421
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21231-1536
Practice Address - Country:US
Practice Address - Phone:410-955-9213
Practice Address - Fax:410-614-9981
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
MDD0011091171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor