Provider Demographics
NPI:1881901023
Name:DALIAH K. SALAHUDDIN MD PA
Entity type:Organization
Organization Name:DALIAH K. SALAHUDDIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:E
Authorized Official - Last Name:KARTISEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-879-3336
Mailing Address - Street 1:20 CROSSROADS DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5419
Mailing Address - Country:US
Mailing Address - Phone:410-902-1144
Mailing Address - Fax:410-902-6391
Practice Address - Street 1:20 CROSSROADS DR
Practice Address - Street 2:SUITE 101
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5419
Practice Address - Country:US
Practice Address - Phone:410-902-1144
Practice Address - Fax:410-902-6391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-09
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD20252207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD766221100Medicaid
MD7652Medicare PIN
MDB69750Medicare UPIN