Basic Information
Provider Information
NPI: 1487630604
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SALLAH
FirstName: MAHMOUD
MiddleName: W
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 14690 SPRING HILL DR STE 305
Address2:  
City: SPRING HILL
State: FL
PostalCode: 346098102
CountryCode: US
TelephoneNumber: 3522775348
FaxNumber: 3526062857
Practice Location
Address1: 1 HOSPITAL WAY
Address2:  
City: BUTLER
State: PA
PostalCode: 160014760
CountryCode: US
TelephoneNumber: 8339950114
FaxNumber: 7242847464
Other Information
ProviderEnumerationDate: 12/20/2005
LastUpdateDate: 08/30/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/30/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RI0200XME76555FLN Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
207RI0200XMD465450PAY Allopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease

No ID Information.


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