Provider Demographics
NPI:1417959776
Name:ABASS, SALAH (MD)
Entity Type:Individual
Prefix:
First Name:SALAH
Middle Name:
Last Name:ABASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 MERRIMACK ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-5821
Mailing Address - Country:US
Mailing Address - Phone:978-682-2808
Mailing Address - Fax:978-686-1924
Practice Address - Street 1:411 MERRIMACK ST
Practice Address - Street 2:SUITE 105
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-5821
Practice Address - Country:US
Practice Address - Phone:978-682-2808
Practice Address - Fax:978-686-1924
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA219722207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ27250OtherBLUE CROSS BLUE SHIELD
MAAA9780OtherHARVARD PILGRIM HEALTHCAR
MA2085780Medicaid
MA468787OtherTUFTS HEALTH PLAN
MA2085780Medicaid
MAA36721Medicare ID - Type Unspecified