Provider Demographics
NPI:1164467288
Name:SALIM, MUBADDA A (MD)
Entity Type:Individual
Prefix:DR
First Name:MUBADDA
Middle Name:A
Last Name:SALIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3700 KOPPERS ST
Mailing Address - Street 2:SUITE #155
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-1019
Mailing Address - Country:US
Mailing Address - Phone:410-644-0550
Mailing Address - Fax:410-644-0533
Practice Address - Street 1:3700 KOPPERS ST
Practice Address - Street 2:SUITE #155
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-1019
Practice Address - Country:US
Practice Address - Phone:410-644-0550
Practice Address - Fax:410-644-0533
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-20
Last Update Date:2012-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0040310174400000X, 2080P0202X
VA0101246900174400000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD161461400Medicaid
VA1164467288Medicaid
MD161461400Medicaid
MDB743Medicare PIN