Provider Demographics
NPI:1265477939
Name:DAN SELIGMAN
Entity Type:Organization
Organization Name:DAN SELIGMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SELIGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:781-391-3900
Mailing Address - Street 1:0 GOVERNORS AVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-3025
Mailing Address - Country:US
Mailing Address - Phone:781-391-3900
Mailing Address - Fax:
Practice Address - Street 1:0 GOVERNORS AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-3025
Practice Address - Country:US
Practice Address - Phone:781-391-3900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAY77191OtherBLUE CROSS BLUE SHIELD
MA1029750001Medicare NSC
MAY78053Medicare PIN