Provider Demographics
NPI:1801897194
Name:SALAHUDDIN, AZHAR I (MD)
Entity type:Individual
Prefix:DR
First Name:AZHAR
Middle Name:I
Last Name:SALAHUDDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1360 E HERNDON AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3326
Mailing Address - Country:US
Mailing Address - Phone:559-449-5050
Mailing Address - Fax:559-432-2632
Practice Address - Street 1:1360 E HERNDON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3326
Practice Address - Country:US
Practice Address - Phone:559-449-5050
Practice Address - Fax:559-432-2632
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101236887207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0802292OtherUNITED HEALTH CARE PROV #
VA541299712OtherVA HEALTH NETWORK PROV #
VA010094682OtherVA PREMIER PROV #
VA144442OtherANTHEM PROV #
VA2342752002OtherCIGNA PROV #
VA144442OtherHEALTHKEEPERS PROV #
VAP00164871OtherRAILROAD MEDICARE PROV #
VA2128853OtherMD IPA PROV #
VA7286537OtherAETNA PROV #
VA79567OtherOPTIMA PROV #
NC89067EYOtherNC MEDICAID PROV #
VA9339127OtherPHCS PROV #
VA010094682Medicaid
VA2222922OtherFIRST HEALTH PROV #
VA541299712OtherVA HEALTH NETWORK PROV #
VA005128V49Medicare ID - Type Unspecified