Provider Demographics
NPI:1871583369
Name:SALVO, JOHN P SR (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:P
Last Name:SALVO
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2410-14 SOUTH BROAD ST
Mailing Address - Street 2:STE 200
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145
Mailing Address - Country:US
Mailing Address - Phone:215-334-3350
Mailing Address - Fax:215-336-6980
Practice Address - Street 1:2410-14 SOUTH BROAD ST
Practice Address - Street 2:STE 200
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145
Practice Address - Country:US
Practice Address - Phone:215-334-3350
Practice Address - Fax:215-336-6980
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD014862E207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0052334000OtherKEYSTONE EAST HMO
PA0009081240002Medicaid
0032976OtherAETNA HMO
PA0056399K6YMedicare ID - Type Unspecified
B96875Medicare UPIN