Provider Demographics
NPI:1811076268
Name:SALAM, ARIFA (MD)
Entity type:Individual
Prefix:
First Name:ARIFA
Middle Name:
Last Name:SALAM
Suffix:
Gender:F
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:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76202-0368
Mailing Address - Country:US
Mailing Address - Phone:940-591-3176
Mailing Address - Fax:
Practice Address - Street 1:3980 STATE SCHOOL RD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-8823
Practice Address - Country:US
Practice Address - Phone:940-591-3176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR146130001Medicaid
MO205400203Medicaid
H45638Medicare UPIN
000095270Medicare ID - Type Unspecified