Provider Demographics
NPI:1386788479
Name:SALAMA, ANDREW RAYMOND (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:RAYMOND
Last Name:SALAMA
Suffix:
Gender:M
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 E NEWTON ST
Mailing Address - Street 2:SUITE 4G07
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2308
Mailing Address - Country:US
Mailing Address - Phone:617-414-4838
Mailing Address - Fax:617-414-4126
Practice Address - Street 1:100 E NEWTON ST
Practice Address - Street 2:SUITE 4G07
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2308
Practice Address - Country:US
Practice Address - Phone:617-414-4838
Practice Address - Fax:617-414-4126
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MADN18553571223S0112X, 204E00000X
MA243606207Y00000X, 207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD829310400Medicaid
MDS029Medicare ID - Type UnspecifiedMH
MDF17157Medicare UPIN
MD829310400Medicaid
MDI14704Medicare UPIN
MDJ384Medicare ID - Type Unspecified
MDH86282Medicare UPIN
MDT83571Medicare UPIN
MDG320Medicare ID - Type Unspecified
MDAV44Medicare ID - Type Unspecified