MEDICARE: DR. JEFFREY C SALOMON M.D.

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	208200000X	Plastic Surgery Physician	G44313	CA
2	208200000X	Plastic Surgery Physician	22604	CT

General Provider Information

NPI Number	:	1205863636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY C SALOMON M.D.

Provider Business Mailing Address
First Line	:	245 AMITY RD
Second Line	:	SUITE 108
City	:	WOODBRIDGE
State	:	CT
Zip	:	06525-2258
Country	:	US
Telephone Number	:	203-624-4346
Fax Number	:	203-562-3221

Provider Business Practice Location Address
First Line	:	245 AMITY RD STE 108
Second Line	:
City	:	WOODBRIDGE
State	:	CT
Zip	:	06525-2258
Country	:	US
Telephone Number	:	203-624-4346
Fax Number	:	203-562-3221

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	03/22/2018

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