Healthcare Provider Details

I. General information

NPI: 1700078250
Provider Name (Legal Business Name): WALID ISSAM EL AYASS M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2007
Last Update Date: 04/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E CARROLL STREET
SALISBURY MD
21801-5422
US

IV. Provider business mailing address

100 E CARROLL STREET
SALISBURY MD
21801-5422
US

V. Phone/Fax

Practice location:
  • Phone: 410-749-1282
  • Fax: 410-749-7821
Mailing address:
  • Phone: 410-543-7531
  • Fax: 410-912-6386

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberD73895
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: