Healthcare Provider Details

I. General information

NPI: 1457395527
Provider Name (Legal Business Name): ALFREDO JESUS SELIM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 11/20/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 VFW PKWY
WEST ROXBURY MA
02132-4927
US

IV. Provider business mailing address

1611 CAMBRIDGE STREET INTERNAL MEDICINE
CAMBRIDGE MA
02138
US

V. Phone/Fax

Practice location:
  • Phone: 617-323-7700
  • Fax:
Mailing address:
  • Phone: 617-661-5100
  • Fax: 617-661-5226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number76321
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number76321
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: