Organization
SELAM MEDICAL SERVICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RUSSOM BARIAGHABER GHEBRAI M.D. (SOLE MBR)
(301) 502-6912
Entity
Organization
Contact information
Practice address
1328 SOUTHERN AVE SE, SUITE 205, WASHINGTON, DC 20032-4689
(202) 544-7744
Mailing address
603 SLIGO AVE, APT 313, SILVER SPRING, MD 20910-4765
(301) 588-0724
Taxonomy
Speciality
Code
Description
License number
State
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
Primary
MD035237
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
059550700
—
DC
Enumeration date
11/02/2009
Last updated
11/02/2009
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