Provider Demographics
NPI:1285722280
Name:SALPIETRO, BENJAMIN JOSEPH JR (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:JOSEPH
Last Name:SALPIETRO
Suffix:JR
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 1:5755 MONCLOVA RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1837
Mailing Address - Country:US
Mailing Address - Phone:419-893-2663
Mailing Address - Fax:419-893-7240
Practice Address - Street 1:5755 MONCLOVA RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1837
Practice Address - Country:US
Practice Address - Phone:419-893-2663
Practice Address - Fax:419-893-7240
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH62058207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000231295OtherANTHEM
OH0459525Medicaid
OH200044049OtherCHAMPUS
OH200044049OtherRAILROAD MEDICARE
OH02411OtherPARAMOUNT
OH5672194OtherAETNA
OH5672194OtherAETNA
OHG39937Medicare UPIN
OH0814164Medicare PIN