MEDICARE: DR. GARY R SALZMAN D.O.

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	207Q00000X	Family Medicine Physician	OS006642L	PA

General Provider Information

NPI Number	:	1356397939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY R SALZMAN D.O.

Provider Business Mailing Address
First Line	:	5945 LANSDOWNE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-3932
Country	:	US
Telephone Number	:	215-878-4585
Fax Number	:

Provider Business Practice Location Address
First Line	:	5945 LANSDOWNE AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19151-3932
Country	:	US
Telephone Number	:	215-878-4585
Fax Number	:

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

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	02/18/2009

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