Basic Information
| Provider Information | |||||||||
| NPI: | 1508831058 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EL-DERINY | ||||||||
| FirstName: | SALAH | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 859207 | ||||||||
| Address2: | |||||||||
| City: | BRAINTREE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021859207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6038939784 | ||||||||
| FaxNumber: | 6038938886 | ||||||||
| Practice Location | |||||||||
| Address1: | 27 PARK ST | ||||||||
| Address2: | CAPE COD HOSPITAL, DEPT. OF PATHOLOGY | ||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 026015230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088625267 | ||||||||
| FaxNumber: | 5087717786 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2006 | ||||||||
| LastUpdateDate: | 12/14/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0102X | 55734 | MA | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
ID Information
| ID | Type | State | Issuer | Description | 3079295 | 05 | MA | MEDICAID | 220032329 | 01 | MA | RAILROAD MEDICARE | OTHER | 600372 | 01 | MA | HARVARD PILGRIM | OTHER | 793997 | 01 | MA | TUFTS HEALTH PLAN | OTHER | J11325 | 01 | MA | BCBS MA | OTHER |