=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497384176
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AHMED BASSAM SALEM DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/05/2020
-----------------------------------------------------
Last Update Date | 04/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 500 J. CLYDE MORRIS BLVD. DEPT OF MEDICAL EDUCATION/ANNEX: 2ND FLOOR
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-612-7200
-----------------------------------------------------
Fax | 757-594-3184
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 500 J. CLYDE MORRIS BLVD. DEPT. OF MEDICAL EDUCATION/ ANNEX: SECOND FLOOR
-----------------------------------------------------
City | NEWPORT NEWS
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-612-7200
-----------------------------------------------------
Fax | 757-594-3184
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | 3258
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------