Provider Demographics
NPI:1437450749
Name:SALOOM, ILYAS (PMH-NP)
Entity Type:Individual
Prefix:
First Name:ILYAS
Middle Name:
Last Name:SALOOM
Suffix:
Gender:M
Credentials:PMH-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 DEWITT LOOP
Mailing Address - Street 2:FBCH - ADULT OUTPATIENT BEHAVIORAL HEALTH
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-5285
Mailing Address - Country:US
Mailing Address - Phone:571-231-1270
Mailing Address - Fax:571-231-6623
Practice Address - Street 1:9300 DEWITT LOOP
Practice Address - Street 2:FBCH - ADULT OUTPATIENT BEHAVIORAL HEALTH
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5285
Practice Address - Country:US
Practice Address - Phone:571-231-1270
Practice Address - Fax:571-231-6623
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170694363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health