Healthcare Provider Details

I. General information

NPI: 1649250135
Provider Name (Legal Business Name): CARL A SALSBURY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 N WASHINGTON STREET #100
FALLS CHURCH VA
22046
US

IV. Provider business mailing address

10400 EATON PLACE #410
FAIRFAX VA
22030
US

V. Phone/Fax

Practice location:
  • Phone: 703-237-5919
  • Fax: 703-241-1863
Mailing address:
  • Phone: 703-359-5160
  • Fax: 703-383-9574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101017484
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: