MEDICARE: DR. MUNKETH SALEM D.P.M.

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	213E00000X	Podiatrist	XX	OH
2	213ES0131X	Foot Surgery Podiatrist	0103301155	VA

General Provider Information

NPI Number	:	1104110857
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MUNKETH SALEM D.P.M.

Provider Business Mailing Address
First Line	:	5311 PATTERSON AVE
Second Line	:	STE 110
City	:	RICHMOND
State	:	VA
Zip	:	23226-2041
Country	:	US
Telephone Number	:	804-285-1523
Fax Number	:

Provider Business Practice Location Address
First Line	:	5311 PATTERSON AVE
Second Line	:	STE 110
City	:	RICHMOND
State	:	VA
Zip	:	23226-2041
Country	:	US
Telephone Number	:	804-285-1523
Fax Number	:

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

Provider Enumeration Date	:	05/29/2011
Last Update Date	:	02/06/2017

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