Provider Demographics
NPI:1679714935
Name:ABDELSALAM, ELSAYED O (MD)
Entity Type:Individual
Prefix:
First Name:ELSAYED
Middle Name:O
Last Name:ABDELSALAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 OLD CAMDEN ROAD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CAMDEN
Mailing Address - State:DE
Mailing Address - Zip Code:19934
Mailing Address - Country:US
Mailing Address - Phone:302-883-3266
Mailing Address - Fax:302-883-3084
Practice Address - Street 1:120 OLD CAMDEN ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:CAMDEN
Practice Address - State:DE
Practice Address - Zip Code:19934
Practice Address - Country:US
Practice Address - Phone:302-883-3266
Practice Address - Fax:302-883-3084
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJPERMIT 07/01/2006208000000X
NJMA08647700208000000X
DEC1-0009475208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA08647700OtherSTATE LICENSE
DEC1-0009475OtherDE LICENSE