Provider Demographics
NPI:1013024579
Name:SALLOUM, MAHA S (MD)
Entity Type:Individual
Prefix:
First Name:MAHA
Middle Name:S
Last Name:SALLOUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7102 WESTWIND DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1726
Mailing Address - Country:US
Mailing Address - Phone:915-581-5100
Mailing Address - Fax:915-581-6100
Practice Address - Street 1:7102 WESTWIND DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-1726
Practice Address - Country:US
Practice Address - Phone:915-581-5100
Practice Address - Fax:915-581-6100
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0554208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171512001Medicaid
TN8H0434OtherBC/BS OF TEXAS
TXBS9166441OtherDEA