Provider Demographics
NPI:1295938090
Name:SELMAN, CARMEN MELANIA (MD)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:MELANIA
Last Name:SELMAN
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:P.O. BOX 452317
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33345-2317
Mailing Address - Country:US
Mailing Address - Phone:954-838-2588
Mailing Address - Fax:954-514-3960
Practice Address - Street 1:1613 N. HARRISON PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323
Practice Address - Country:US
Practice Address - Phone:954-838-2588
Practice Address - Fax:954-514-3960
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98552207V00000X, 207L00000X
GA057260207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279075100Medicaid