Provider Demographics
NPI:1457389561
Name:SELONICK, STUART E (MD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:E
Last Name:SELONICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 12622
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4017
Mailing Address - Country:US
Mailing Address - Phone:443-481-6571
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2003 MEDICAL PKWY
Practice Address - Street 2:SUITE 210
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7992
Practice Address - Country:US
Practice Address - Phone:410-573-5300
Practice Address - Fax:410-573-5305
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD016364207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KR65MG95Medicare PIN
171493Y5ZMedicare PIN
B69746Medicare UPIN