1124151287 NPI number — DR. SHUJA U SALEEM MD

Table of content: DR. SHUJA U SALEEM MD (NPI 1124151287)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124151287 NPI number — DR. SHUJA U SALEEM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALEEM
Provider First Name:
SHUJA
Provider Middle Name:
U
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124151287
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
31 STILES RD
Provider Second Line Business Mailing Address:
SUITE 2100
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03079-2897
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-890-2600
Provider Business Mailing Address Fax Number:
603-870-0992

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31 STILES RD
Provider Second Line Business Practice Location Address:
SUITE 2100
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03079-2897
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-890-2600
Provider Business Practice Location Address Fax Number:
603-870-0992
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  37039 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VG0400X , with the licence number: 5617 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P01599407 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 6143504 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3103437 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: CO7083 . This is a "BLUE CROSS BLUE SHIELD MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: D78714 . This is a "HARVARD PILGRIM HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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