=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114936804
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GULRUKH SALEEM INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/05/2006
-----------------------------------------------------
Last Update Date | 01/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44075 PIPELINE PLZ SUITE 200
-----------------------------------------------------
City | ASHBURN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20147-5881
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-209-3732
-----------------------------------------------------
Fax | 703-349-6476
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 664
-----------------------------------------------------
City | ASHBURN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20146-0664
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-209-3732
-----------------------------------------------------
Fax | 703-349-6476
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | VICE PRESIDENT
-----------------------------------------------------
Name | MRS. GULRUKH SALEEM
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 703-209-3732
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RR0500X
-----------------------------------------------------
Taxonomy Name | Rheumatology Physician
-----------------------------------------------------
License Number | 0101232354
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------