Provider Demographics
NPI:1982703138
Name:SALERNO, GINO (PA)
Entity Type:Individual
Prefix:
First Name:GINO
Middle Name:
Last Name:SALERNO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:929 N SAINT FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3821
Mailing Address - Country:US
Mailing Address - Phone:316-268-5775
Mailing Address - Fax:316-291-7496
Practice Address - Street 1:929 N SAINT FRANCIS ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214-3821
Practice Address - Country:US
Practice Address - Phone:316-268-5775
Practice Address - Fax:316-291-7496
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00799363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100212200BMedicaid
KS100374070DMedicaid
KS9846OtherPREFERRED HEALTH SYSTEMS
KS042108OtherBCBS
KS110990019Medicare PIN