Provider Demographics
NPI:1730288879
Name:SALEM, GREGG (PHD)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:
Last Name:SALEM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9899 MAIN ST
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-2064
Mailing Address - Country:US
Mailing Address - Phone:301-253-6331
Mailing Address - Fax:301-253-6331
Practice Address - Street 1:9899 MAIN ST
Practice Address - Street 2:SUITE 201A
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-2064
Practice Address - Country:US
Practice Address - Phone:301-253-6331
Practice Address - Fax:301-253-6331
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3277103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist