Provider Demographics
NPI:1922205079
Name:ZAKY SALAMA, WADID YOUSSEF (MD)
Entity Type:Individual
Prefix:
First Name:WADID
Middle Name:YOUSSEF
Last Name:ZAKY SALAMA
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 1:2145 COUNTRY CLUB RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-2400
Mailing Address - Country:US
Mailing Address - Phone:910-939-5759
Mailing Address - Fax:910-939-4951
Practice Address - Street 1:2145 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-2400
Practice Address - Country:US
Practice Address - Phone:910-939-5759
Practice Address - Fax:910-939-4951
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101252883207LP2900X
NC2016-00023207LP2900X
MA232877207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1922205079Medicaid