Provider Demographics
NPI:1184620064
Name:SELTZER, JEFFREY P (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:P
Last Name:SELTZER
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 1:79 WAWECUS ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2160
Mailing Address - Country:US
Mailing Address - Phone:860-886-2679
Mailing Address - Fax:860-889-2862
Practice Address - Street 1:79 WAWECUS ST
Practice Address - Street 2:SUITE 106
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2160
Practice Address - Country:US
Practice Address - Phone:860-886-2679
Practice Address - Fax:860-889-2862
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT024565207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001245653Medicaid
CTB74134Medicare UPIN
CT060000163Medicare PIN