Provider Demographics
NPI:1154378669
Name:SALAMAT, MEHRDAD (MD)
Entity type:Individual
Prefix:
First Name:MEHRDAD
Middle Name:
Last Name:SALAMAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6247
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-8466
Mailing Address - Country:US
Mailing Address - Phone:361-452-4404
Mailing Address - Fax:361-452-4407
Practice Address - Street 1:5802 SARATOGA BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414
Practice Address - Country:US
Practice Address - Phone:361-452-4404
Practice Address - Fax:361-452-4407
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL17282080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8H9853OtherBCBSTX
TX141268602Medicaid
TX120044OtherSUPERIOR HEALTHPLAN
TX141268602OtherCSHCN
TXH31471Medicare UPIN
TX8H9853OtherBCBSTX