Provider Demographics
NPI:1811052079
Name:SELIGSON, VALERIE BETH (OD)
Entity type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:BETH
Last Name:SELIGSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64481
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4481
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10700 CHARTER DR
Practice Address - Street 2:SUITE 140
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3629
Practice Address - Country:US
Practice Address - Phone:301-908-2676
Practice Address - Fax:410-910-2393
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000280152W00000X
VA0601001213152W00000X
MDTA0895152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD027593000Medicaid
MD027593000Medicaid