Provider Demographics
NPI:1134105166
Name:SELLECK, WILLIAM ALBERT (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALBERT
Last Name:SELLECK
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 1:4 ELLIOT WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-3547
Mailing Address - Country:US
Mailing Address - Phone:603-669-9200
Mailing Address - Fax:603-624-2210
Practice Address - Street 1:4 ELLIOT WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-3547
Practice Address - Country:US
Practice Address - Phone:603-669-9200
Practice Address - Fax:603-624-2210
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH11976208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH81343603Medicaid
NHH89618Medicare UPIN
NHRE7297Medicare ID - Type UnspecifiedMEDICARE