Provider Demographics
NPI:1740213230
Name:BAHRALILOM, SALAH (MD)
Entity Type:Individual
Prefix:
First Name:SALAH
Middle Name:
Last Name:BAHRALILOM
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 1:89 GENESEE ST
Mailing Address - Street 2:WALK IN CARE CENTER
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14611-3201
Mailing Address - Country:US
Mailing Address - Phone:585-368-3053
Mailing Address - Fax:
Practice Address - Street 1:89 GENESEE ST
Practice Address - Street 2:WALK IN CARE CENTER
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14611-3201
Practice Address - Country:US
Practice Address - Phone:585-368-3053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY223389207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY223898WOtherWORKMEN'S COMPENSATION
NYDD1096 - 70008A GRPMedicare PIN
NY223898WOtherWORKMEN'S COMPENSATION
H46230Medicare UPIN