Healthcare Provider Details

I. General information

NPI: 1700263944
Provider Name (Legal Business Name): YASIR SALEEM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 06/08/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 E OLD STURBRIDGE RD
BRIMFIELD MA
01010-9647
US

IV. Provider business mailing address

PO BOX 40
SOUTHBRIDGE MA
01550-0040
US

V. Phone/Fax

Practice location:
  • Phone: 413-245-3389
  • Fax: 413-245-4553
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number279003
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: