Healthcare Provider Details

I. General information

NPI: 1992788525
Provider Name (Legal Business Name): HENRY H SALZARULO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10630 CLEMSON BLVD 200
SENECA SC
29678-4546
US

IV. Provider business mailing address

PO BOX 2585
COLUMBUS GA
31902-2585
US

V. Phone/Fax

Practice location:
  • Phone: 864-882-3351
  • Fax: 706-660-9390
Mailing address:
  • Phone: 706-660-8505
  • Fax: 706-660-9390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number13790
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number13790
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: