Provider Demographics
NPI:1124025416
Name:SALTZMAN, MELVIN BORIS (DO)
Entity type:Individual
Prefix:
First Name:MELVIN
Middle Name:BORIS
Last Name:SALTZMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12277 DE PAUL DR
Mailing Address - Street 2:STE 404
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2536
Mailing Address - Country:US
Mailing Address - Phone:314-770-1000
Mailing Address - Fax:314-770-2456
Practice Address - Street 1:12277 DE PAUL DR
Practice Address - Street 2:STE 404
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2536
Practice Address - Country:US
Practice Address - Phone:314-770-1000
Practice Address - Fax:314-770-2456
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR5B20207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A10869Medicare UPIN
001013335Medicare ID - Type Unspecified