Provider Demographics
NPI:1821173311
Name:SALVA-OTERO, ROBERTO B (MD)
Entity Type:Individual
Prefix:
First Name:ROBERTO
Middle Name:B
Last Name:SALVA-OTERO
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 1:2085 RIVERDALE ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-1025
Mailing Address - Country:US
Mailing Address - Phone:413-650-7546
Mailing Address - Fax:413-650-7506
Practice Address - Street 1:2085 RIVERDALE ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1025
Practice Address - Country:US
Practice Address - Phone:413-650-7546
Practice Address - Fax:717-674-4274
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0153869Medicaid
MAH50544Medicare UPIN
MAH50544Medicare UPIN