Provider Demographics
NPI:1881673168
Name:MCPHERSON, SELWYN-LLOYD EWART (MD)
Entity Type:Individual
Prefix:
First Name:SELWYN-LLOYD
Middle Name:EWART
Last Name:MCPHERSON
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 1:3632 WEST MARKET ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2494
Mailing Address - Country:US
Mailing Address - Phone:330-836-5333
Mailing Address - Fax:330-836-1775
Practice Address - Street 1:3632 WEST MARKET ST
Practice Address - Street 2:SUITE 102
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-2494
Practice Address - Country:US
Practice Address - Phone:330-836-5333
Practice Address - Fax:330-836-1775
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048211M2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C02447Medicare UPIN