Provider Demographics
NPI: | 1679748024 |
---|---|
Name: | SALERNO, MICHAEL (MD, PHD) |
Entity Type: | Individual |
Prefix: | |
First Name: | MICHAEL |
Middle Name: | |
Last Name: | SALERNO |
Suffix: | |
Gender: | M |
Credentials: | MD, PHD |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 300 PASTEUR DR |
Mailing Address - Street 2: | |
Mailing Address - City: | STANFORD |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94305-2200 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 650-723-4000 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 300 PASTEUR DR |
Practice Address - Street 2: | |
Practice Address - City: | STANFORD |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94305-2200 |
Practice Address - Country: | US |
Practice Address - Phone: | 650-723-4000 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2008-04-28 |
Last Update Date: | 2024-04-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | 0101243587 | 207RC0000X |
CA | A88153 | 207UN0901X, 207RC0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No | 207UN0901X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
VA | 1679748024 | Medicaid | |
VA | 1679748024 | Medicaid | |
VA | VAA101343 | Medicare PIN |