Individual
MARIANA SALAS-VEGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1 SHAWS CV, NEW LONDON, CT 06320
(860) 447-8304
(860) 443-8720
Mailing address
575 MAIN ST FL 2, ATTN: CREDENTIALING DEPT, MIDDLETOWN, CT 06457-2845
(860) 347-6971
(860) 638-6831
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
051831
CT
390200000X
Student in an Organized Health Care Education/Training Program
TRN12337
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004236346
—
CT
Enumeration date
05/30/2008
Last updated
08/03/2018
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