Provider Demographics
NPI:1588790323
Name:SALEEM, SOGRA R (MD)
Entity type:Individual
Prefix:
First Name:SOGRA
Middle Name:R
Last Name:SALEEM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1 MARK CERMELE CT
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-1069
Mailing Address - Country:US
Mailing Address - Phone:732-577-8790
Mailing Address - Fax:732-409-7517
Practice Address - Street 1:1 MARK CERMELE CT
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-1069
Practice Address - Country:US
Practice Address - Phone:732-577-8790
Practice Address - Fax:732-409-7517
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA03480700207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0579700Medicaid
NJ0579700Medicaid
NJE52474Medicare UPIN