Healthcare Provider Details

I. General information

NPI: 1881127405
Provider Name (Legal Business Name): SANDRA MARIE SALZMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 3215
APO AE
09094-3215
US

IV. Provider business mailing address

UNIT 3215
APO AE
09094-3215
US

V. Phone/Fax

Practice location:
  • Phone: 314-479-2609
  • Fax: 314-479-2610
Mailing address:
  • Phone: 314-479-2609
  • Fax: 314-479-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberMD-20392
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: