Provider Demographics
NPI:1043369218
Name:SALZANO, ANDRIA M (PAC)
Entity type:Individual
Prefix:MS
First Name:ANDRIA
Middle Name:M
Last Name:SALZANO
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 OFFICE PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013
Mailing Address - Country:US
Mailing Address - Phone:513-844-1000
Mailing Address - Fax:513-896-3727
Practice Address - Street 1:25 OFFICE PARK DRIVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013
Practice Address - Country:US
Practice Address - Phone:513-844-1000
Practice Address - Fax:513-896-3727
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2353363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000492642OtherANTHEM
OHSAPA26751Medicare ID - Type Unspecified
Q68403Medicare UPIN