Provider Demographics
NPI:1801879747
Name:SEIDMAN, DAVID N (EDD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:N
Last Name:SEIDMAN
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 HIDDEN LAIR DR
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-1368
Mailing Address - Country:US
Mailing Address - Phone:215-699-3605
Mailing Address - Fax:
Practice Address - Street 1:8302 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-1522
Practice Address - Country:US
Practice Address - Phone:215-572-6517
Practice Address - Fax:215-576-7816
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003335L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASE1252597OtherBLUE CROSS
PA1664285OtherPERSONAL CHOICE
PASE1252597OtherBLUE CROSS
PAR06351Medicare UPIN