Provider Demographics
NPI:1790758530
Name:SHERIF, SALAH A (MD)
Entity Type:Individual
Prefix:
First Name:SALAH
Middle Name:A
Last Name:SHERIF
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 1:9221 SIERRA COLLEGE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-5919
Mailing Address - Country:US
Mailing Address - Phone:916-780-1343
Mailing Address - Fax:916-780-1365
Practice Address - Street 1:9221 SIERRA COLLEGE BLVD
Practice Address - Street 2:STE 300
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-5919
Practice Address - Country:US
Practice Address - Phone:916-780-1343
Practice Address - Fax:916-780-1365
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC529720207P00000X
CAC52972207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C529720Medicaid
TN4108441OtherBLUECROSS BLUESHIELD
TN3086742Medicaid
TN4108441OtherBLUECROSS BLUESHIELD
CABG030ZMedicare PIN
3887338Medicare ID - Type Unspecified
CABD123XMedicare PIN
E19296Medicare UPIN
CA00C529721Medicare PIN