Healthcare Provider Details

I. General information

NPI: 1275978033
Provider Name (Legal Business Name): MARYANN SALIB D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

861 E ALLEGHENY AVE
PHILADELPHIA PA
19134-2401
US

IV. Provider business mailing address

4417 N 6TH ST
PHILADELPHIA PA
19140-2319
US

V. Phone/Fax

Practice location:
  • Phone: 215-831-1100
  • Fax:
Mailing address:
  • Phone: 215-302-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberOS019463
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: