Basic Information
| Provider Information | |||||||||
| NPI: | 1457341745 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SALOPEK | ||||||||
| FirstName: | EDWARD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1070 OLD NATIONAL PIKE | ||||||||
| Address2: | |||||||||
| City: | FREDERICKTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153332114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7246326801 | ||||||||
| FaxNumber: | 7246326801 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 MCKEAN AVE | ||||||||
| Address2: | |||||||||
| City: | CHARLEROI | ||||||||
| State: | PA | ||||||||
| PostalCode: | 150221558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7244835482 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2005 | ||||||||
| LastUpdateDate: | 08/17/2011 | ||||||||
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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 | 207Q00000X | MD420508 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001522329 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 100815940 | 05 | PA | MEDICAID |