Healthcare Provider Details

I. General information

NPI: 1497782304
Provider Name (Legal Business Name): RABIH M SALLOUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/05/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE BOX SURG
ROCHESTER NY
14642-8410
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX SURG
ROCHESTER NY
14642-8410
US

V. Phone/Fax

Practice location:
  • Phone: 585-273-2727
  • Fax: 585-276-2203
Mailing address:
  • Phone: 585-273-2727
  • Fax: 585-276-2203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number219236
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number219236
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number219236
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: