Provider Demographics
NPI:1558306225
Name:SALAHUDDIN, KAZI (MD)
Entity Type:Individual
Prefix:
First Name:KAZI
Middle Name:
Last Name:SALAHUDDIN
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 1:528 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-5757
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:520 HOPE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2532
Practice Address - Country:US
Practice Address - Phone:401-276-4155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD101772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI408610OtherBLUE CHIP
RI007059460OtherMEDICARE ID-TYPE UNSPECIFIED
RI30881-8OtherBLUE CROSS
1093831646OtherBUTLER HOSPITAL PROFESSIONAL BILLING OFFICE
RI1104801349OtherBUTLER HOSPITAL NPI
RI1104847946OtherTHE PROVIDENCE CENTER NPI
RI7008981Medicaid
RI15-14122OtherUNITED BEHAVIORAL HEALTH
RI1104801349OtherBUTLER HOSPITAL NPI