Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301085639 | MI |
N | 2080P0210X | Pediatric Nephrologist | 4301085639 | MI |
Y | 2080P0210X | Pediatric Nephrologist | 82049 | SC |
NPI | 1265556989 |
---|---|
Provider Name | Dr. David Thomas Selewski |
First Address | Charlotte, NC 28275-1461 |
Second Address | Charleston, SC 29425-4259 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 29/05/2019 |