Healthcare Provider Details

I. General information

NPI: 1629303532
Provider Name (Legal Business Name): LEE SALTZGABER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 10/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CHALAN PADIRON
CHALAN PAGO GU
96913
US

IV. Provider business mailing address

PO BOX 1732
HAGATNA GU
96932-1732
US

V. Phone/Fax

Practice location:
  • Phone: 671-687-7637
  • Fax:
Mailing address:
  • Phone: 671-687-7637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-1528
License Number StateGU
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD054304L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: