Basic Information
| Provider Information | |||||||||
| NPI: | 1285722280 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SALPIETRO | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5755 MONCLOVA RD | ||||||||
| Address2: | |||||||||
| City: | MAUMEE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435371837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198932663 | ||||||||
| FaxNumber: | 4198937240 | ||||||||
| Practice Location | |||||||||
| Address1: | 5755 MONCLOVA RD | ||||||||
| Address2: | |||||||||
| City: | MAUMEE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435371837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198932663 | ||||||||
| FaxNumber: | 4198937240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2006 | ||||||||
| LastUpdateDate: | 10/12/2007 | ||||||||
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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 | 207X00000X | 62058 | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 000000231295 | 01 | OH | ANTHEM | OTHER | 0459525 | 05 | OH | MEDICAID | 200044049 | 01 | OH | CHAMPUS | OTHER | 200044049 | 01 | OH | RAILROAD MEDICARE | OTHER | 02411 | 01 | OH | PARAMOUNT | OTHER | 5672194 | 01 | OH | AETNA | OTHER |