1386671436 NPI number — ROBERT HARRIS SALVAGE MD

Table of content: BRAD A MYERS MD (NPI 1700986635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386671436 NPI number — ROBERT HARRIS SALVAGE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALVAGE
Provider First Name:
ROBERT
Provider Middle Name:
HARRIS
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:
1386671436
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
813 E GATE DR STE B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT LAUREL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08054-1238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-985-2727
Provider Business Mailing Address Fax Number:
856-394-2756

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2760 CENTURY BLVD STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYOMISSING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19610-3359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-376-9607
Provider Business Practice Location Address Fax Number:
610-376-9662
Provider Enumeration Date:
06/26/2006

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: 207LP2900X , with the licence number:  25MA06859100 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X , with the licence number: MD048442L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00210395 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0141062 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 22-1994560 . This is a "QUALCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 23-2919275 . This is a "UNITED HEALTHCARE/OXFORD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 23-2919275 . This is a "DEVON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0676444000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1201397 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 146710 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 22-1994560 . This is a "GREAT WEST HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 22-1994560 . This is a "FIRST MCO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 22-1994560 . This is a "HORIZON BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 23-2919275 . This is a "HORIZON BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 23-2919275 . This is a "QUALCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 50059327 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 001646007 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22-1994560 . This is a "UNITED HEALTHCARE/OXFORD" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0676444000 . This is a "IBC PRODUCTS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1162120 . This is a "HORIZON MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1770846 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 23-2919275 . This is a "HEALTH AMERICA/HEALTH ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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