Provider Demographics
NPI:1992733299
Name:SALOOM, ALBERT TIMOTHY (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:TIMOTHY
Last Name:SALOOM
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 1:6533 ROUTE 819
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:PA
Mailing Address - Zip Code:15666-2665
Mailing Address - Country:US
Mailing Address - Phone:724-547-5501
Mailing Address - Fax:724-547-5510
Practice Address - Street 1:6533 ROUTE 819
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:PA
Practice Address - Zip Code:15666-2665
Practice Address - Country:US
Practice Address - Phone:724-547-5501
Practice Address - Fax:724-547-5510
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-071720-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01845360Medicaid
PA049553SL3Medicare ID - Type Unspecified
PAH43041Medicare UPIN