Provider Demographics
NPI:1326075698
Name:MASCARENHAS, SELVAM JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:SELVAM
Middle Name:JOSEPH
Last Name:MASCARENHAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:111 CONTINENTAL DR
Mailing Address - Street 2:SUITE 406
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4306
Mailing Address - Country:US
Mailing Address - Phone:302-368-2630
Mailing Address - Fax:302-368-1271
Practice Address - Street 1:111 CONTINENTAL DR
Practice Address - Street 2:SUITE 406
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4306
Practice Address - Country:US
Practice Address - Phone:302-368-2630
Practice Address - Fax:302-368-1271
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2008-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
DEC1-0008046207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I69956Medicare UPIN
DEG02723I13Medicare PIN