Provider Demographics
NPI:1942302740
Name:SALAMONE, JOHN ALFRED (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALFRED
Last Name:SALAMONE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 LAKESIDE E AVE 1200
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44114-1172
Mailing Address - Country:US
Mailing Address - Phone:216-524-7377
Mailing Address - Fax:
Practice Address - Street 1:5105 SOM CENTER RD
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-4203
Practice Address - Country:US
Practice Address - Phone:216-524-7377
Practice Address - Fax:440-953-5728
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2016-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36002455213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2603285Medicaid
SA4029231Medicare ID - Type Unspecified
T80653Medicare UPIN