Provider Demographics
NPI:1265476782
Name:SELBY, MARK R (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:SELBY
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:PO BOX 1007
Mailing Address - Street 2:
Mailing Address - City:ASHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01330-1007
Mailing Address - Country:US
Mailing Address - Phone:413-499-2672
Mailing Address - Fax:413-447-8825
Practice Address - Street 1:73 EAGLE ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4714
Practice Address - Country:US
Practice Address - Phone:413-499-2672
Practice Address - Fax:413-447-8825
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MAMA43107207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2464892OtherID#