Provider Demographics
NPI:1457476319
Name:ROBERTO B. SALVA-OTERO, MD, LLC
Entity Type:Organization
Organization Name:ROBERTO B. SALVA-OTERO, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:B
Authorized Official - Last Name:SALVA-OTERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-650-7546
Mailing Address - Street 1:488 NEWTON ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-2010
Mailing Address - Country:US
Mailing Address - Phone:413-532-9092
Mailing Address - Fax:413-532-7082
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAH50544Medicare UPIN
MAM21789Medicare PIN