Provider Demographics
NPI:1114090479
Name:SALAH AL-ANDARY M D LLC
Entity Type:Organization
Organization Name:SALAH AL-ANDARY M D LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SALAH
Authorized Official - Middle Name:F
Authorized Official - Last Name:AL ANDARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-584-1344
Mailing Address - Street 1:1920 WEST BAY DRIVE
Mailing Address - Street 2:SUITE #6
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770
Mailing Address - Country:US
Mailing Address - Phone:727-584-1344
Mailing Address - Fax:727-584-7855
Practice Address - Street 1:1920 WEST BAY DRIVE
Practice Address - Street 2:SUITE #6
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770
Practice Address - Country:US
Practice Address - Phone:727-584-1344
Practice Address - Fax:727-584-7855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLME0073452207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252165200Medicaid
G52284Medicare UPIN
FLK3307Medicare PIN