Healthcare Provider Details

I. General information

NPI: 1689767378
Provider Name (Legal Business Name): EMRE U SELI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 GEORGE ST STE 770
NEW HAVEN CT
06511-6624
US

IV. Provider business mailing address

103 PECK HILL ROAD
WOODBRIDGE CT
06525
US

V. Phone/Fax

Practice location:
  • Phone: 203-785-4018
  • Fax: 203-785-7134
Mailing address:
  • Phone: 203-675-6654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number039322
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: