Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 39785 | MA |
NPI | 1316938202 |
---|---|
Provider Name | Dr. Edward Bert Seldin |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02114-3117 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0154415 | (05) | MA |
703300 | TUFTS HEALTH PLAN (01) | MA |
M09396 | BCBS MA (01) | MA |
T80101 | (02) |