Healthcare Provider Details

I. General information

NPI: 1003847765
Provider Name (Legal Business Name): PHILIP SALAMANDER M.A., CCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

990 S MARION ST
MARTINSVILLE IN
46151-2438
US

IV. Provider business mailing address

403 PAINTED HLS
MARTINSVILLE IN
46151-8678
US

V. Phone/Fax

Practice location:
  • Phone: 765-342-5497
  • Fax:
Mailing address:
  • Phone: 765-342-2568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number455
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: