MEDICARE: SALAM H RAJJOUB MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	20559	WV

General Provider Information

NPI Number	:	1366483083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALAM H RAJJOUB MD

Provider Business Mailing Address
First Line	:	PO BOX 6230
Second Line	:
City	:	WHEELING
State	:	WV
Zip	:	26003-0722
Country	:	US
Telephone Number	:	304-242-7106
Fax Number	:	304-242-7108

Provider Business Practice Location Address
First Line	:	700 GENESIS BLVD
Second Line	:
City	:	BRIDGEPORT
State	:	WV
Zip	:	26330-9668
Country	:	US
Telephone Number	:	304-848-2040
Fax Number	:	304-848-2042

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	10/27/2020

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