Provider Demographics
NPI:1336152982
Name:SALEM, CAROL (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:SALEM
Suffix:
Gender:F
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:PO BOX 33865
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-3865
Mailing Address - Country:US
Mailing Address - Phone:858-888-7700
Mailing Address - Fax:858-888-7721
Practice Address - Street 1:4060 4TH AVE
Practice Address - Street 2:STE 310
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2116
Practice Address - Country:US
Practice Address - Phone:619-297-4707
Practice Address - Fax:858-429-7927
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75788208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G757880Medicaid
CABN720XOtherMEDICARE PTAN FOR GHP
CA00G757880Medicaid
CAWG75788AMedicare ID - Type Unspecified