Healthcare Provider Details

I. General information

NPI: 1710074620
Provider Name (Legal Business Name): SELINA CORTEZ CORTEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LAKE AVE N DEPARTMENT OF ANATOMIC PATHOLOGY
WORCESTER MA
01655-0002
US

IV. Provider business mailing address

67 SLADES FERRY AVE STE 6720
SOMERSET MA
02726-1220
US

V. Phone/Fax

Practice location:
  • Phone: 508-793-6100
  • Fax: 508-793-6110
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License Number246286
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number246286
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD08686
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: