1376524256 NPI number — MOHAMMAD - SALEEM MD

Employer Identification Number (EIN)	:
Provider Organization Name (Legal Business Name)	:
Provider Last Name (Legal Name)	:	SALEEM
Provider First Name	:	MOHAMMAD
Provider Middle Name	:	-
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Provider Credential Text	:	MD
Provider Gender Code	:	M

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NPI Number	:	1376524256
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	07/08/2007
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Provider First Line Business Mailing Address	:	4211 DUSTIN RD
Provider Second Line Business Mailing Address	:
Provider Business Mailing Address City Name	:	BURTONSVILLE
Provider Business Mailing Address State Name	:	MD
Provider Business Mailing Address Postal Code	:	208661020
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	3014211025
Provider Business Mailing Address Fax Number	:	3014211703

Provider First Line Business Practice Location Address	:	55 WADE AVE
Provider Second Line Business Practice Location Address	:
Provider Business Practice Location Address City Name	:	CATONSVILLE
Provider Business Practice Location Address State Name	:	MD
Provider Business Practice Location Address Postal Code	:	212284663
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	4104026000
Provider Business Practice Location Address Fax Number	:
Provider Enumeration Date	:	11/08/2005

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• Taxonomy code: 207Q00000X , with the licence number:  D40610 , registered in the state of MD .