Healthcare Provider Details

I. General information

NPI: 1043207947
Provider Name (Legal Business Name): SABA SALAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 11/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 WESTERN AVE
BRATTLEBORO VT
05301-6147
US

IV. Provider business mailing address

830 WESTERN AVE
BRATTLEBORO VT
05301-6147
US

V. Phone/Fax

Practice location:
  • Phone: 802-246-0781
  • Fax: 802-246-0742
Mailing address:
  • Phone: 802-246-0781
  • Fax: 802-246-0742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number42-0010331
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: