Provider Demographics
NPI:1982994331
Name:SALAM, TANVIR US (MD)
Entity Type:Individual
Prefix:
First Name:TANVIR
Middle Name:US
Last Name:SALAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MATTBEN DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-7142
Mailing Address - Country:US
Mailing Address - Phone:561-419-3856
Mailing Address - Fax:
Practice Address - Street 1:11 MATTBEN DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-7142
Practice Address - Country:US
Practice Address - Phone:561-419-3856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01071137A207R00000X, 207RP1001X, 207RC0200X
NC2012-01639207R00000X
FLME 108596208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5921773Medicaid
SCNC1737Medicaid
IN201296370Medicaid
IN259370099OtherIN MEDICARE
IN259370099OtherIN MEDICARE
IN201296370Medicaid