Provider Demographics
NPI:1710969282
Name:SALURAND, ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:SALURAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 ROUTE 171
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:CT
Mailing Address - Zip Code:06281-3123
Mailing Address - Country:US
Mailing Address - Phone:860-928-7775
Mailing Address - Fax:860-928-1397
Practice Address - Street 1:168 ROUTE 171
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:CT
Practice Address - Zip Code:06281-3123
Practice Address - Country:US
Practice Address - Phone:860-928-7775
Practice Address - Fax:860-928-1397
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1612682084N0400X
CT382272084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3205371Medicaid
MAA3045501Medicare PIN
MAH08569Medicare UPIN