Provider Demographics
NPI:1700018587
Name:SALAM, SHAMEEN ABDUL (MD)
Entity Type:Individual
Prefix:
First Name:SHAMEEN
Middle Name:ABDUL
Last Name:SALAM
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 1:1910 SASSAFRAS ST
Mailing Address - Street 2:STE 100
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2716
Mailing Address - Country:US
Mailing Address - Phone:814-878-0290
Mailing Address - Fax:
Practice Address - Street 1:145 W 23RD ST
Practice Address - Street 2:STE 302A
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2858
Practice Address - Country:US
Practice Address - Phone:814-878-0290
Practice Address - Fax:814-878-0291
Is Sole Proprietor?:No
Enumeration Date:2009-08-12
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD454681207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103056067Medicaid
PA451258Medicare PIN