MEDICARE: SALAH ABASS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	219722	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	J27250	OTHER	MA	BLUE CROSS BLUE SHIELD
2	AA9780	OTHER	MA	HARVARD PILGRIM HEALTHCAR
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	468787	OTHER	MA	TUFTS HEALTH PLAN

General Provider Information

NPI Number	:	1417959776
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALAH ABASS M.D.

Provider Business Mailing Address
First Line	:	411 MERRIMACK ST
Second Line	:	SUITE 105
City	:	METHUEN
State	:	MA
Zip	:	01844-5821
Country	:	US
Telephone Number	:	978-682-2808
Fax Number	:	978-686-1924

Provider Business Practice Location Address
First Line	:	411 MERRIMACK ST
Second Line	:	SUITE 105
City	:	METHUEN
State	:	MA
Zip	:	01844-5821
Country	:	US
Telephone Number	:	978-682-2808
Fax Number	:	978-686-1924

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	04/08/2009

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