Provider Demographics
NPI:1477663458
Name:SALLADE, GARY ALAN (PA)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:ALAN
Last Name:SALLADE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:DR
Other - First Name:SAEREE
Other - Middle Name:
Other - Last Name:JANE-WIT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:27 COVENTRY DR
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-1012
Mailing Address - Country:US
Mailing Address - Phone:740-775-0364
Mailing Address - Fax:
Practice Address - Street 1:17273 STATE ROUTE 104
Practice Address - Street 2:
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8608
Practice Address - Country:US
Practice Address - Phone:740-773-1141
Practice Address - Fax:740-772-7061
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050922363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical