Provider Demographics
NPI:1811041528
Name:ANDRES SALAZAR P A
Entity Type:Organization
Organization Name:ANDRES SALAZAR P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-530-0454
Mailing Address - Street 1:3621 LIGON RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5238
Mailing Address - Country:US
Mailing Address - Phone:410-530-0454
Mailing Address - Fax:
Practice Address - Street 1:3621 LIGON RD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-5238
Practice Address - Country:US
Practice Address - Phone:410-530-0454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051051207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDY04572Medicare UPIN
MDG01467Medicare ID - Type UnspecifiedGROUP #