Provider Demographics
NPI:1972675007
Name:SALEEM, AHMED MUSTAFA (MD)
Entity Type:Individual
Prefix:DR
First Name:AHMED
Middle Name:MUSTAFA
Last Name:SALEEM
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 1:8404 TUCKERMAN LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3156
Mailing Address - Country:US
Mailing Address - Phone:301-299-0332
Mailing Address - Fax:
Practice Address - Street 1:8404 TUCKERMAN LN
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3156
Practice Address - Country:US
Practice Address - Phone:301-299-0332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235543207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1972675007Medicaid
MD413958500Medicaid
VA013063V16Medicare PIN
C08616Medicare PIN
MD211NMedicare PIN
P00396295Medicare PIN