Provider Demographics
NPI:1144499450
Name:SALTZMAN, STUART MARK
Entity type:Individual
Prefix:MR
First Name:STUART
Middle Name:MARK
Last Name:SALTZMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SHEP
Other - Middle Name:
Other - Last Name:SALTZMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11160C1 S LAKES DR # 155
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-4327
Mailing Address - Country:US
Mailing Address - Phone:703-915-1369
Mailing Address - Fax:571-410-0208
Practice Address - Street 1:11870 SUNRISE VALLEY DR STE 100
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3303
Practice Address - Country:US
Practice Address - Phone:703-915-1369
Practice Address - Fax:703-571-2028
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-21
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001053446163W00000X
VA0121000100171100000X
VA0024189245363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No171100000XOther Service ProvidersAcupuncturist