Provider Demographics
NPI:1922059062
Name:ALWAN, ABDAL SALAM H (MD)
Entity Type:Individual
Prefix:DR
First Name:ABDAL SALAM
Middle Name:H
Last Name:ALWAN
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 1:2223 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760
Mailing Address - Country:US
Mailing Address - Phone:716-372-7515
Mailing Address - Fax:716-372-7541
Practice Address - Street 1:2223 W STATE ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760
Practice Address - Country:US
Practice Address - Phone:716-372-7515
Practice Address - Fax:716-372-7541
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1740991207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011532740001OtherMEDICAL ASSISTANCE OF PA
NY000510873001OtherBCBC OF WNY CB
00010003201OtherUNIVERA
0804200OtherINDEPENDENT HEALTH
5890698OtherAETNA
NY01146712Medicaid
NY040403006457OtherFIDELIS CARE
180008527OtherRR MEDICARE
NY01146712Medicaid
PA0011532740001OtherMEDICAL ASSISTANCE OF PA