Provider Demographics
NPI:1932355963
Name:SALTIEL, DOREEN (MD)
Entity Type:Individual
Prefix:
First Name:DOREEN
Middle Name:
Last Name:SALTIEL
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 1:66 TAMERLANE WAY
Mailing Address - Street 2:
Mailing Address - City:LEICESTER
Mailing Address - State:NC
Mailing Address - Zip Code:28748-4506
Mailing Address - Country:US
Mailing Address - Phone:796-526-4664
Mailing Address - Fax:866-352-5436
Practice Address - Street 1:66 TAMERLANE WAY
Practice Address - Street 2:
Practice Address - City:LEICESTER
Practice Address - State:NC
Practice Address - Zip Code:28748-4506
Practice Address - Country:US
Practice Address - Phone:479-652-6466
Practice Address - Fax:866-352-5436
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2023-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2017-01977207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200206380AMedicaid
AR5H332Medicare PIN
AR173736001Medicaid