Healthcare Provider Details

I. General information

NPI: 1861524621
Provider Name (Legal Business Name): GIANVITO L SALERNO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOHNVITO L SALERNO M.D.

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 W UNIVERSITY AVE
MUNCIE IN
47303-3428
US

IV. Provider business mailing address

250 N SHADELAND AVE
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 765-747-4374
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number240519
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number01067668A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number01067668A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number240519
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: