Provider Demographics
NPI:1861456741
Name:SELONICK, MARTHA S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:S
Last Name:SELONICK
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:7350 VAN DUSEN RD
Mailing Address - Street 2:STE 130
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5267
Mailing Address - Country:US
Mailing Address - Phone:301-560-4747
Mailing Address - Fax:301-776-1725
Practice Address - Street 1:8850 COLUMBIA 100 PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2374
Practice Address - Country:US
Practice Address - Phone:301-560-4747
Practice Address - Fax:301-776-1725
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2017-04-04
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Provider Licenses
StateLicense IDTaxonomies
MDD0019676207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD257651100Medicaid
MD257651100Medicaid
MD034MO776Medicare PIN