Provider Demographics
NPI:1295922797
Name:SALIB, MAGDA FAWZY (MD)
Entity type:Individual
Prefix:
First Name:MAGDA
Middle Name:FAWZY
Last Name:SALIB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAGDA
Other - Middle Name:FAWZY
Other - Last Name:MAKRAM/SALIB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2626 TAMPA RD
Mailing Address - Street 2:STE 101
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3155
Mailing Address - Country:US
Mailing Address - Phone:727-754-1984
Mailing Address - Fax:727-754-2868
Practice Address - Street 1:2626 TAMPA RD
Practice Address - Street 2:STE 101
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3155
Practice Address - Country:US
Practice Address - Phone:727-754-1984
Practice Address - Fax:727-754-2868
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME114184208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics