Provider Demographics
NPI:1003848235
Name:SELNER, MARC D (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:D
Last Name:SELNER
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:4335 LAUREL CANYON BLVD
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-1710
Mailing Address - Country:US
Mailing Address - Phone:818-763-9330
Mailing Address - Fax:818-763-5061
Practice Address - Street 1:4335 LAUREL CANYON BLVD
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-1710
Practice Address - Country:US
Practice Address - Phone:818-763-9330
Practice Address - Fax:818-763-5061
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE1619213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE1619Medicare PIN