Provider Demographics
NPI:1336135839
Name:SELDEN, SAMUEL THWING (MD)
Entity Type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:THWING
Last Name:SELDEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:200 MEDICAL PKWY
Mailing Address - Street 2:STE 309
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4911
Mailing Address - Country:US
Mailing Address - Phone:757-547-9241
Mailing Address - Fax:757-547-5741
Practice Address - Street 1:200 MEDICAL PKWY
Practice Address - Street 2:STE 309
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4911
Practice Address - Country:US
Practice Address - Phone:757-547-9241
Practice Address - Fax:757-547-5741
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101033093207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5996937Medicaid
VA5996937Medicaid