Provider Demographics
NPI:1386639755
Name:SELYA, LEONID (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:LEONID
Middle Name:
Last Name:SELYA
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7404 EXECUTIVE PL STE 350
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-6268
Mailing Address - Country:US
Mailing Address - Phone:301-599-9500
Mailing Address - Fax:240-542-2959
Practice Address - Street 1:8116 GOOD LUCK RD STE 200
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3508
Practice Address - Country:US
Practice Address - Phone:301-599-9500
Practice Address - Fax:301-552-7483
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0055085207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD424901100Medicaid
G79457Medicare UPIN
MD424901100Medicaid