Provider Demographics
NPI:1376732826
Name:SELTZER, SIDNEY MARVIN (MD)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:MARVIN
Last Name:SELTZER
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 1:9304 MEDICAL PLAZA DR STE D
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-9143
Mailing Address - Country:US
Mailing Address - Phone:843-820-2020
Mailing Address - Fax:843-797-5512
Practice Address - Street 1:9304 MEDICAL PLAZA DR STE D
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-9143
Practice Address - Country:US
Practice Address - Phone:843-820-2020
Practice Address - Fax:843-797-5512
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5618207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCCL2394OtherRAILROAD MEDICARE
SCPA1603Medicaid
SC1522OtherMEDICARE
SCC612731522Medicare PIN
SC5911Medicare PIN
SC1522OtherMEDICARE
SCCL2394OtherRAILROAD MEDICARE
SCPA1603Medicaid
SC5909Medicare PIN