Provider Demographics
NPI:1235343922
Name:EL-BASH, SALAH MOHAMMED (MD)
Entity type:Individual
Prefix:
First Name:SALAH
Middle Name:MOHAMMED
Last Name:EL-BASH
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 1:37 MARIPOSA PKWY W
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2220
Mailing Address - Country:US
Mailing Address - Phone:304-634-4464
Mailing Address - Fax:
Practice Address - Street 1:1711 27TH ST STE 206
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-2669
Practice Address - Country:US
Practice Address - Phone:740-356-8772
Practice Address - Fax:740-354-2138
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.124245207RI0011X
WI2881207RI0011X
TXR0564207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35.124245OtherOH LICENSE
TXR0564OtherMD LICENSE
WV2177885OtherUHC
WV613154600OtherBLACK LUNG
KY7100048970Medicaid
OH2851589Medicaid
WV9468161OtherAETNA
WV3810012378Medicaid
WV4239721Medicare PIN