Healthcare Provider Details

I. General information

NPI: 1164467288
Provider Name (Legal Business Name): MUBADDA A SALIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 12/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 KOPPERS ST SUITE #155
BALTIMORE MD
21227-1019
US

IV. Provider business mailing address

3700 KOPPERS ST SUITE #155
BALTIMORE MD
21227-1019
US

V. Phone/Fax

Practice location:
  • Phone: 410-644-0550
  • Fax: 410-644-0533
Mailing address:
  • Phone: 410-644-0550
  • Fax: 410-644-0533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0040310
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberD0040310
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101246900
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number0101246900
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: