Provider Demographics
NPI:1710196712
Name:SBAITY, SALAM A (MD)
Entity type:Individual
Prefix:DR
First Name:SALAM
Middle Name:A
Last Name:SBAITY
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 1:2000 MON HEALTH MEDICAL PARK DR STE 2300
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1168
Mailing Address - Country:US
Mailing Address - Phone:304-599-8802
Mailing Address - Fax:304-599-5607
Practice Address - Street 1:2000 MON HEALTH MEDICAL PARK DR STE 2300
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1168
Practice Address - Country:US
Practice Address - Phone:304-599-8802
Practice Address - Fax:304-599-4898
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV29619207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA42141730725OtherUHC/RIVER VALLEY/JD PREMIER
IA1710196712Medicaid
WV1710196712Medicaid