Provider Demographics
NPI:1780748798
Name:LAURIA, SALVATORE S (MD)
Entity type:Individual
Prefix:
First Name:SALVATORE
Middle Name:S
Last Name:LAURIA
Suffix:
Gender:M
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 12622
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4017
Mailing Address - Country:US
Mailing Address - Phone:443-481-6577
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:888 BESTGATE RD
Practice Address - Street 2:SUITE 208
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3091
Practice Address - Country:US
Practice Address - Phone:410-897-0822
Practice Address - Fax:410-897-0095
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2015-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD41034207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AT540002OtherCAREFIRST
DCG00747OtherDC MEDICAID
MD54339007OtherBLUE SHIELD
MD685504100Medicaid
DCE6260001OtherGHI
DCG00747OtherDC MEDICAID
DCE6260001OtherGHI
MD54339007OtherBLUE SHIELD