Basic Information
| Provider Information | |||||||||
| NPI: | 1043369218 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALZANO | ||||||||
| FirstName: | ANDRIA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 OFFICE PARK DRIVE | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138441000 | ||||||||
| FaxNumber: | 5138963727 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 OFFICE PARK DRIVE | ||||||||
| Address2: | |||||||||
| City: | HAMILTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138441000 | ||||||||
| FaxNumber: | 5138963727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 2353 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 000000492642 | 01 | ANTHEM | OTHER |