Healthcare Provider Details

I. General information

NPI: 1184030777
Provider Name (Legal Business Name): HAITHM A.S. ABDELSALAM M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2014
Last Update Date: 10/09/2025
Certification Date: 10/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

489 STATE ST
BANGOR ME
04401-6616
US

IV. Provider business mailing address

PO BOX 650859 DEPT 710
DALLAS TX
75265-0859
US

V. Phone/Fax

Practice location:
  • Phone: 207-275-0987
  • Fax:
Mailing address:
  • Phone: 409-772-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberV9745
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberV9745
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: