Provider Demographics
NPI:1720033038
Name:SALEH, ADEL (M D)
Entity Type:Individual
Prefix:
First Name:ADEL
Middle Name:
Last Name:SALEH
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 LANDRUM PL STE B
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-4648
Mailing Address - Country:US
Mailing Address - Phone:931-552-5594
Mailing Address - Fax:931-551-3671
Practice Address - Street 1:312 LANDRUM PL STE B
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4648
Practice Address - Country:US
Practice Address - Phone:931-552-5594
Practice Address - Fax:931-551-3671
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000021527207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3060706Medicaid
TN3060706Medicaid
TNE32970Medicare UPIN