=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487630604
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAHMOUD W SALLAH MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/20/2005
-----------------------------------------------------
Last Update Date | 08/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 HOSPITAL WAY
-----------------------------------------------------
City | BUTLER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16001-4760
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 833-995-0114
-----------------------------------------------------
Fax | 724-284-7464
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14690 SPRING HILL DR STE 305
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34609-8102
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-277-5348
-----------------------------------------------------
Fax | 352-606-2857
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number | ME76555
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RI0200X
-----------------------------------------------------
Taxonomy Name | Infectious Disease Physician
-----------------------------------------------------
License Number | MD465450
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------