Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 0101241479 | VA |
NPI | 1104945997 |
---|---|
Provider Name | Dr. Lee Selznick |
First Address | Winchester, VA 22601-2869 |
Second Address | Winchester, VA 22601-2869 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 10/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1104945997 | (05) | VA |
358707 | ANTHEM BCBS (01) | VA |
3810009350 | (05) | WV |
I72730 | (02) | VA |
P00657226 | MEDICARE RR (01) | VA |