Provider Demographics
NPI:1174695506
Name:PAPA, SALVADOR (MD)
Entity type:Individual
Prefix:MR
First Name:SALVADOR
Middle Name:
Last Name:PAPA
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 1:2446 MOUNTAIN RD
Mailing Address - Street 2:SUITE 102C
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122
Mailing Address - Country:US
Mailing Address - Phone:410-255-3045
Mailing Address - Fax:410-255-0899
Practice Address - Street 1:2446 MOUNTAIN RD
Practice Address - Street 2:SUITE 102C
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122
Practice Address - Country:US
Practice Address - Phone:410-255-3045
Practice Address - Fax:410-255-0899
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD27002208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
C57760Medicare UPIN