1033214812 NPI number — MATTHEW G SALTARELLI MD

Table of content: MATTHEW G SALTARELLI MD (NPI 1033214812)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033214812 NPI number — MATTHEW G SALTARELLI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALTARELLI
Provider First Name:
MATTHEW
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033214812
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 6TH ST SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44710-1702
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-833-5530
Provider Business Mailing Address Fax Number:
330-833-6085

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 SIXTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-438-6311
Provider Business Practice Location Address Fax Number:
330-580-5546
Provider Enumeration Date:
09/14/2006

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: 207ZP0102X , with the licence number:  35-068412 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0169491 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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