Healthcare Provider Details

I. General information

NPI: 1841350899
Provider Name (Legal Business Name): SALAM PSYCHIATRIC SERVICES, P.L.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 TECHNOLOGY DRIVE # 9
BRATTLEBORO VT
05301
US

IV. Provider business mailing address

20 TECHNOLOGY DRI # 9
BRATTLEBORO VT
05301
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: DR. SABA MAHEEN SALAM
Title or Position: MANAGER
Credential: M.D.
Phone: 802-246-0781