1063675114 NPI number — DR. CAMELIA LOREDANA SALANTA M.D.

Table of content: DR. CAMELIA LOREDANA SALANTA M.D. (NPI 1063675114)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063675114 NPI number — DR. CAMELIA LOREDANA SALANTA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALANTA
Provider First Name:
CAMELIA
Provider Middle Name:
LOREDANA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LUNGU
Provider Other First Name:
CAMELIA
Provider Other Middle Name:
LOREDANA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063675114
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26015 GREENFIELD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTHFIELD
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48076-4703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-552-7230
Provider Business Mailing Address Fax Number:
248-552-7514

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26015 GREENFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHFIELD
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48076-4703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-552-7230
Provider Business Practice Location Address Fax Number:
248-552-7514
Provider Enumeration Date:
07/09/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  4301092507 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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