Healthcare Provider Details

I. General information

NPI: 1992733299
Provider Name (Legal Business Name): ALBERT TIMOTHY SALOOM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6533 ROUTE 819
MOUNT PLEASANT PA
15666-2665
US

IV. Provider business mailing address

6533 ROUTE 819
MOUNT PLEASANT PA
15666-2665
US

V. Phone/Fax

Practice location:
  • Phone: 724-547-5501
  • Fax: 724-547-5510
Mailing address:
  • Phone: 724-547-5501
  • Fax: 724-547-5510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-071720-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: