Provider Demographics
NPI:1548329006
Name:SALAM, CATHERINE MOORE (CNM)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:MOORE
Last Name:SALAM
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 NORTH CHARLES STREET
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201
Mailing Address - Country:US
Mailing Address - Phone:410-837-2050
Mailing Address - Fax:443-573-5027
Practice Address - Street 1:1111 NORTH CHARLES STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201
Practice Address - Country:US
Practice Address - Phone:410-837-2050
Practice Address - Fax:443-573-5027
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR101103367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD020451000Medicaid
163611YT3Medicare PIN