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General NPI Number Information
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NPI Number | 1699819219
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Entity Type | Organization
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Legal Business Name | E J SALON MD INC
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 06/10/2008
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Provider Practice Location Address
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Address Line | 200 RALEIGH AVE
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City | BECKLEY
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State | WV
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Zip | 25801-5944
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Country | US
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Telephone | 304-252-8541
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Fax | 304-253-2507
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Provider Business Mailing Address
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Address Line | 200 RALEIGH AVE
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City | BECKLEY
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State | WV
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Zip | 25801-5944
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Country | US
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Telephone | 304-252-8541
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Fax | 304-253-2507
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Authorized Official
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Title or Position | PRSIDENT
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Name | ELY J SALON
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Credential | M.D.
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Telephone | 304-252-8541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 18381
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License Number State | WV
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