Provider Demographics
NPI:1023009727
Name:SELLERS, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SELLERS
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 1:805 N RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:FLEETWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19522-1058
Mailing Address - Country:US
Mailing Address - Phone:610-944-0464
Mailing Address - Fax:610-944-9733
Practice Address - Street 1:805 N RICHMOND ST
Practice Address - Street 2:
Practice Address - City:FLEETWOOD
Practice Address - State:PA
Practice Address - Zip Code:19522-1058
Practice Address - Country:US
Practice Address - Phone:610-944-0464
Practice Address - Fax:610-944-9733
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023321E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA142747JPUMedicare PIN
PAB39358Medicare UPIN