Provider Demographics
NPI:1144308677
Name:SALEM, GEORGE JR (DPM)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:SALEM
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-1809
Mailing Address - Country:US
Mailing Address - Phone:413-737-2360
Mailing Address - Fax:413-737-1718
Practice Address - Street 1:1380 ELM ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1809
Practice Address - Country:US
Practice Address - Phone:413-737-2360
Practice Address - Fax:413-737-1718
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1824213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0361879Medicaid
MA5019518OtherTRICARE/CHAMPUS
MAT58790Medicare UPIN
MAY70839Medicare ID - Type Unspecified