Provider Demographics
NPI:1659365682
Name:SELSKY, EVAN J (MD)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:J
Last Name:SELSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:193 STONER AVE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5587
Mailing Address - Country:US
Mailing Address - Phone:410-871-9800
Mailing Address - Fax:410-871-9801
Practice Address - Street 1:193 STONER AVE
Practice Address - Street 2:SUITE 340
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5587
Practice Address - Country:US
Practice Address - Phone:410-871-9800
Practice Address - Fax:410-871-9801
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2011-12-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0033388207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
D37622Medicare UPIN
000LA704Medicare ID - Type Unspecified