Healthcare Provider Details

I. General information

NPI: 1053773358
Provider Name (Legal Business Name): WALID KHALID ABU SALEH MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

900 E FORT AVE APT 516
BALTIMORE MD
21230-5290
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-7399
  • Fax:
Mailing address:
  • Phone: 703-303-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberD0086426
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: