Provider Demographics
NPI:1386117794
Name:MSALAM M SARA MD INC
Entity type:Organization
Organization Name:MSALAM M SARA MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MSALAM
Authorized Official - Middle Name:MTANOUS
Authorized Official - Last Name:SARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-610-2001
Mailing Address - Street 1:PO BOX 33142
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95031-3142
Mailing Address - Country:US
Mailing Address - Phone:408-610-2001
Mailing Address - Fax:408-610-3880
Practice Address - Street 1:2550 SAMARITAN DR STE D
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4104
Practice Address - Country:US
Practice Address - Phone:408-298-0433
Practice Address - Fax:408-295-8818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-08
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA72788OtherSTATE LICENSE