Provider Demographics
NPI:1760436364
Name:SELHUB, EVA MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:MICHELLE
Last Name:SELHUB
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOPX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIANS ORGANIZATION INC
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:824 BOYLSTON ST
Practice Address - Street 2:MIND/BODY MEDICAL INSTITUTE
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2508
Practice Address - Country:US
Practice Address - Phone:617-991-0102
Practice Address - Fax:617-991-0112
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MA152152207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3166104Medicaid
MAJ17746OtherBLUE CROSS BLUE SHIELD
MAA22410Medicare ID - Type Unspecified
MAJ17746OtherBLUE CROSS BLUE SHIELD