Provider Demographics
NPI:1083673149
Name:SELIM, WILLIAM D (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:D
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 1:630 PLANTATION ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605
Mailing Address - Country:US
Mailing Address - Phone:508-852-8570
Mailing Address - Fax:508-852-1022
Practice Address - Street 1:630 PLANTATION ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605
Practice Address - Country:US
Practice Address - Phone:508-852-8570
Practice Address - Fax:508-852-1022
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50186208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
28364OtherCHILDRENS MEDICAL SECURIT
H05070OtherBLUE SHIELD HMO BLUE
042472266OtherONE HEALTH PLAN
4570514OtherAETNA US HEALTHCARE
6658558OtherCIGNA HEALTH PLAN
784189OtherMVP HEALTH CARE
MA0181919Medicaid
H05070OtherMEDICARE B
1293416OtherFALLON COMMUNITY HEALTH P
0181919OtherMEDICAID WELFARE
H05070OtherBLUE CARE ELECT
28364OtherHEALTHY START
H05070OtherBLUE SHIELD INDEMNITY
2047118OtherFIRST HEALTH
AA1270OtherHARVARD PILGRIM HEALTHCAR
H05070OtherMEDICARE B
MA0181919Medicaid