Provider Demographics
NPI:1265407647
Name:SELVARAJ, CARRIE LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:LYNN
Last Name:SELVARAJ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-2556
Mailing Address - Country:US
Mailing Address - Phone:989-754-3349
Mailing Address - Fax:989-755-1365
Practice Address - Street 1:1015 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-2556
Practice Address - Country:US
Practice Address - Phone:989-754-3349
Practice Address - Fax:989-755-1365
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081968207RC0000X
TXM9643207RC0000X
MI4301098713207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194328403Medicaid
TX194328403Medicaid