Provider Demographics
NPI:1154133080
Name:TARESH, SALEH JAWAD
Entity type:Individual
Prefix:
First Name:SALEH
Middle Name:JAWAD
Last Name:TARESH
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:N/A
Other - Middle Name:N/A
Other - Last Name:N/A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MR
Mailing Address - Street 1:677 ROOSEVELT TRL # 104
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-5212
Mailing Address - Country:US
Mailing Address - Phone:617-980-3670
Mailing Address - Fax:
Practice Address - Street 1:677 ROOSEVELT TRL # 104
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5212
Practice Address - Country:US
Practice Address - Phone:617-980-3670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver