Healthcare Provider Details

I. General information

NPI: 1932562584
Provider Name (Legal Business Name): BRIDGEPORT BEHAVIORAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2016
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 MEDICAL PARK DR SUITE 105
BRIDGEPORT WV
26330-9008
US

IV. Provider business mailing address

527 MEDICAL PARK DR SUITE 105
BRIDGEPORT WV
26330-9008
US

V. Phone/Fax

Practice location:
  • Phone: 304-933-3885
  • Fax: 304-933-3887
Mailing address:
  • Phone: 304-933-3885
  • Fax: 304-933-3887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateWV

VIII. Authorized Official

Name: DR. MUHAMMAD SALMAN
Title or Position: PSYCHIATRIST
Credential: M.D.
Phone: 304-933-3885