Provider Demographics
NPI:1063483063
Name:SELIM, ASHRAF S (MD)
Entity Type:Individual
Prefix:DR
First Name:ASHRAF
Middle Name:S
Last Name:SELIM
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 1:178 SAVIN STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-2316
Mailing Address - Country:US
Mailing Address - Phone:781-322-5600
Mailing Address - Fax:781-322-7032
Practice Address - Street 1:178 SAVIN STREET
Practice Address - Street 2:SUITE 500
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-2316
Practice Address - Country:US
Practice Address - Phone:781-322-5600
Practice Address - Fax:781-322-7032
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50533174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3091546Medicaid
MA110122569OtherRAILROAD MEDICARE
MA3091546Medicaid
J12319Medicare PIN
MAF26091Medicare UPIN