Healthcare Provider Details

I. General information

NPI: 1992863450
Provider Name (Legal Business Name): SALEM PEDIATRICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7111 NORTH MAIN ST
DAYTON OH
45415-2565
US

IV. Provider business mailing address

7111 NORTH MAIN ST
DAYTON OH
45415-2565
US

V. Phone/Fax

Practice location:
  • Phone: 937-277-6595
  • Fax: 937-277-6998
Mailing address:
  • Phone: 937-277-6595
  • Fax: 937-277-6998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MAHESH M SHAH
Title or Position: PRESIDENT
Credential:
Phone: 937-377-6595