=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669556411
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHELTEN MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2006
-----------------------------------------------------
Last Update Date | 02/18/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2135 E CHELTEN AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19138-2534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-424-5365
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2135 E CHELTEN AVE
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19138-2534
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-424-5365
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. GARY R SALZMAN
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 215-424-5365
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | OS006642L
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------