Provider Demographics
NPI:1932375854
Name:CASELLA, SALVATORE R (MD)
Entity Type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:R
Last Name:CASELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12 TWIN PINES CT
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29928-2936
Mailing Address - Country:US
Mailing Address - Phone:843-979-5363
Mailing Address - Fax:843-671-5363
Practice Address - Street 1:12 TWIN PINES CT
Practice Address - Street 2:
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29928-2936
Practice Address - Country:US
Practice Address - Phone:843-979-5363
Practice Address - Fax:843-671-5363
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-30
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02329800207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1932375854Medicare UPIN