Provider Demographics
NPI:1952736225
Name:SALOMON, MIGUEL ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:ANTONIO
Last Name:SALOMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 COMMERCE AVENUE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015
Mailing Address - Country:US
Mailing Address - Phone:717-240-1322
Mailing Address - Fax:717-240-0382
Practice Address - Street 1:1533 COMMERCE AVENUE
Practice Address - Street 2:SUITE 1
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015
Practice Address - Country:US
Practice Address - Phone:717-240-1322
Practice Address - Fax:717-240-0382
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD039585E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010969640016Medicaid
506222FNNMedicare Oscar/Certification