Provider Demographics
NPI:1417983412
Name:SELTZER, LAWRENCE G (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:G
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 1:97 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-2421
Mailing Address - Country:US
Mailing Address - Phone:973-635-2000
Mailing Address - Fax:973-635-1749
Practice Address - Street 1:97 MAIN ST
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NJ
Practice Address - Zip Code:07928-2421
Practice Address - Country:US
Practice Address - Phone:973-635-2000
Practice Address - Fax:973-635-1749
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA062633002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6584705Medicaid
NJ6584705Medicaid
NJ0000037854Medicare PIN
NJ784453B84Medicare PIN