1164467288 NPI number — DR. MUBADDA A SALIM MD

Table of content: DR. MUBADDA A SALIM MD (NPI 1164467288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164467288 NPI number — DR. MUBADDA A SALIM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SALIM
Provider First Name:
MUBADDA
Provider Middle Name:
A
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:
1164467288
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3700 KOPPERS ST
Provider Second Line Business Mailing Address:
SUITE #155
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21227-1019
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-644-0550
Provider Business Mailing Address Fax Number:
410-644-0533

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3700 KOPPERS ST
Provider Second Line Business Practice Location Address:
SUITE #155
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21227-1019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-644-0550
Provider Business Practice Location Address Fax Number:
410-644-0533
Provider Enumeration Date:
06/20/2006

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: 174400000X , with the licence number:  D0040310 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080P0202X , with the licence number: D0040310 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 0101246900 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0202X , with the licence number: 0101246900 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 161461400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1164467288 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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