Healthcare Provider Details

I. General information

NPI: 1083673149
Provider Name (Legal Business Name): WILLIAM D SELIM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2006
Last Update Date: 02/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 PLANTATION ST
WORCESTER MA
01605
US

IV. Provider business mailing address

630 PLANTATION ST
WORCESTER MA
01605
US

V. Phone/Fax

Practice location:
  • Phone: 508-852-8570
  • Fax: 508-852-1022
Mailing address:
  • Phone: 508-852-8570
  • Fax: 508-852-1022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number50186
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: