Provider Demographics
NPI:1932165008
Name:SALISBURY, ROGER E (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:E
Last Name:SALISBURY
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 1:45 EASTERN POINT RD
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-4139
Mailing Address - Country:US
Mailing Address - Phone:914-438-1752
Mailing Address - Fax:978-282-0977
Practice Address - Street 1:45 EASTERN POINT RD
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-4139
Practice Address - Country:US
Practice Address - Phone:914-438-1752
Practice Address - Fax:978-282-0977
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14725412086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00639689Medicaid
NYB16665Medicare UPIN
NY57A081Medicare PIN