MEDICARE: CHELSEA TIFFANY SALAS-TAM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QS0010X	Sports Medicine (Family Medicine) Physician	MD480194	PA
2	207Q00000X	Family Medicine Physician	MD480194	PA

General Provider Information

NPI Number	:	1003435884
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHELSEA TIFFANY SALAS-TAM

Provider Business Mailing Address
First Line	:	4417 N 6TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-2319
Country	:	US
Telephone Number	:	215-302-3600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2940 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-2801
Country	:	US
Telephone Number	:	215-302-3600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2020
Last Update Date	:	01/17/2025

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