Provider Demographics
NPI:1932169109
Name:SELIG, ROBERT MARK (MD, FAAP)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MARK
Last Name:SELIG
Suffix:
Gender:M
Credentials:MD, FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8945 RIDGE AVE
Mailing Address - Street 2:SUITES 3, 4 & 5
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2036
Mailing Address - Country:US
Mailing Address - Phone:215-483-8558
Mailing Address - Fax:215-487-1270
Practice Address - Street 1:8945 RIDGE AVE
Practice Address - Street 2:SUITES 3, 4 & 5
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-2036
Practice Address - Country:US
Practice Address - Phone:215-483-8558
Practice Address - Fax:215-487-1270
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019761E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE63829Medicare UPIN