Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 35078190 | OH |
N | 207R00000X | Internist | 35078190 | OH |
N | 111NI0900X | Internist | 35078190 | OH |
NPI | 1003838087 |
---|---|
Provider Name | Ali Salim |
First Address | Baltimore, MD 21275-0001 |
Second Address | Mount Vernon, OH 43050-1440 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000475287 | BLUE SHIELD (01) | OH |
2125515 | (05) | OH |
G97274 | (02) | OH |