Healthcare Provider Details

I. General information

NPI: 1073164828
Provider Name (Legal Business Name): DALLAS SELTZER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 MAIN STREET 3RD FL, SUITE C&D
SPRINGFIELD MA
01107-1112
US

IV. Provider business mailing address

280 CHESTNUT ST FL 2
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-5600
  • Fax: 413-794-7297
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA061043
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: