Provider Demographics
NPI:1891810776
Name:SELBY, DAVID (IDC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:SELBY
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MOORE ST
Mailing Address - Street 2:
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904-1335
Mailing Address - Country:US
Mailing Address - Phone:207-438-5970
Mailing Address - Fax:207-438-3838
Practice Address - Street 1:BUILDING H-1, 1 AYRES CIRCLE
Practice Address - Street 2:PORTSMOUTH NAVAL SHIPYARD
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03804-5000
Practice Address - Country:US
Practice Address - Phone:207-438-5970
Practice Address - Fax:207-438-3838
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman