Provider Demographics
NPI:1467446120
Name:GHIASUDDIN, SALMAN (MD)
Entity Type:Individual
Prefix:MR
First Name:SALMAN
Middle Name:
Last Name:GHIASUDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HENRY GRAF ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950
Mailing Address - Country:US
Mailing Address - Phone:978-462-1110
Mailing Address - Fax:978-462-3889
Practice Address - Street 1:7 HENRY GRAF ROAD
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950
Practice Address - Country:US
Practice Address - Phone:978-462-1110
Practice Address - Fax:978-462-3889
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2020-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150483207RC0000X, 207RI0011X
NH12423207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3090678Medicaid
MA3191044Medicaid
NH30200119Medicaid
NH3090678Medicaid
MAG18758Medicare UPIN
MASX2551Medicare PIN
MAA29408Medicare PIN
NHRE7701Medicare PIN