Provider Demographics
NPI:1780978296
Name:SALEM, MAHMOUD AWNI (DPM)
Entity type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:AWNI
Last Name:SALEM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1934 BRAEBURN DR
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-7302
Mailing Address - Country:US
Mailing Address - Phone:540-982-0253
Mailing Address - Fax:540-982-1996
Practice Address - Street 1:1934 BRAEBURN DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7302
Practice Address - Country:US
Practice Address - Phone:540-982-0253
Practice Address - Fax:540-982-1996
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-01
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0103301104213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine