Provider Demographics
NPI:1891836722
Name:SALA, MICHAEL E (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:E
Last Name:SALA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 W 12TH ST
Mailing Address - Street 2:STE 200
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16501-1750
Mailing Address - Country:US
Mailing Address - Phone:814-452-2796
Mailing Address - Fax:814-454-7484
Practice Address - Street 1:128 W 12TH ST
Practice Address - Street 2:STE 200
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16501-1750
Practice Address - Country:US
Practice Address - Phone:814-452-2796
Practice Address - Fax:814-454-7484
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010295L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1394079OtherHIGHMARK
PA7568333OtherAETNA
PA000000132925OtherTHREE RIVERS
PA203391OtherHEATHAMERICA
PAH55334Medicare UPIN
PA054906E67Medicare ID - Type Unspecified