Provider Demographics
NPI:1609077288
Name:SALAMA, TREZA GUERGUES (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TREZA
Middle Name:GUERGUES
Last Name:SALAMA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:TREZA
Other - Middle Name:GUERGUES
Other - Last Name:BOCTOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2313 CARR CT
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1787
Mailing Address - Country:US
Mailing Address - Phone:410-461-7137
Mailing Address - Fax:
Practice Address - Street 1:1515 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-1735
Practice Address - Country:US
Practice Address - Phone:410-396-0616
Practice Address - Fax:410-396-7897
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001382363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant