Basic Information
| Provider Information | |||||||||
| NPI: | 1235274911 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALTER | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | CHARLES | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 122 DEFENSE HWY | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214017069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102669694 | ||||||||
| FaxNumber: | 4102669695 | ||||||||
| Practice Location | |||||||||
| Address1: | 122 DEFENSE HWY | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | ANNAPOLIS | ||||||||
| State: | MD | ||||||||
| PostalCode: | 214017069 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102669694 | ||||||||
| FaxNumber: | 4102669695 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 04/20/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | D65535 | MD | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084N0600X | D65535 | MD | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Clinical Neurophysiology | 2084N0008X | D65535 | MD | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neuromuscular Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1235274911 | 01 | RAILROAD MEDICARE | OTHER |