Healthcare Provider Details

I. General information

NPI: 1255377586
Provider Name (Legal Business Name): STEVEN E. SELDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 COTTAGE GROVE RD
BLOOMFIELD CT
06002-3123
US

IV. Provider business mailing address

510 COTTAGE GROVE RD
BLOOMFIELD CT
06002-3123
US

V. Phone/Fax

Practice location:
  • Phone: 860-243-1414
  • Fax: 860-286-0510
Mailing address:
  • Phone: 860-243-1414
  • Fax: 860-286-0510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number21134
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier001211341
Identifier TypeMEDICAID
Identifier StateCT
Identifier Issuer
# 2
Identifier0384440001
Identifier TypeOTHER
Identifier State
Identifier IssuerDMERC
# 3
Identifier200025714
Identifier TypeOTHER
Identifier StateCT
Identifier IssuerRAILROAD MEDICARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: