Provider Demographics
NPI:1902988371
Name:SALVATORE, MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:SALVATORE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:
Practice Address - Street 1:175 MADISON AVE FL 2
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060
Practice Address - Country:US
Practice Address - Phone:609-914-6198
Practice Address - Fax:609-246-9565
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA67975207V00000X
NJ25MA06797500207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1168943OtherHORIZON NJ HEALTH
NJ2999985OtherAETNA
NJ2996399OtherAETAN
NJ010004337OtherAMERICHOICE
NJ2090473000OtherAMERIHEALTH/KEYSTONE/IBC
NJ2303137OtherUNITED HEALHCARE
NJ3K6162OtherHEALTHNET
NJP2753911OtherOXFORD
NJP2753911OtherOXFORD