Provider Demographics
NPI:1780856559
Name:MARTIN E. SALM, M.D., LTD
Entity Type:Organization
Organization Name:MARTIN E. SALM, M.D., LTD
Other - Org Name:ADVANCED COSMETIC SURGERY AND DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-588-5000
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
Practice Address - Street 2:SUITE 101
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6357207N00000X, 207ND0101X, 207ND0900X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Multi-Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002003058Medicaid
NV102228Medicare PIN
NVE32516Medicare UPIN