MEDICARE: ANDRES MARIO SALAZAR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	MD5188	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MD5188	OTHER	DC	MEDICAL LICENSE

General Provider Information

NPI Number	:	1205445996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRES MARIO SALAZAR MD

Provider Business Mailing Address
First Line	:	3203 CLEVELAND AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20008-3450
Country	:	US
Telephone Number	:	202-342-1726
Fax Number	:

Provider Business Practice Location Address
First Line	:	3203 CLEVELAND AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20008-3450
Country	:	US
Telephone Number	:	202-342-1726
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2020
Last Update Date	:	07/28/2020

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