Provider Demographics
NPI:1992846984
Name:SALLOUM, SADEK (MD)
Entity Type:Individual
Prefix:DR
First Name:SADEK
Middle Name:
Last Name:SALLOUM
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 1:127 LARCH RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-3316
Mailing Address - Country:US
Mailing Address - Phone:617-256-3495
Mailing Address - Fax:
Practice Address - Street 1:127 LARCH RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-3316
Practice Address - Country:US
Practice Address - Phone:617-256-3495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157042207K00000X, 208000000X, 2080P0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology