Healthcare Provider Details

I. General information

NPI: 1730212929
Provider Name (Legal Business Name): PETER JAMES SELL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 12/23/2023
Certification Date: 12/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LAKE AVE N
WORCESTER MA
01655-0002
US

IV. Provider business mailing address

14 PROSPECT ST DEPARTMENT OF PEDIATRICS
MILFORD MA
01757-3003
US

V. Phone/Fax

Practice location:
  • Phone: 774-442-2853
  • Fax: 774-443-7268
Mailing address:
  • Phone: 508-422-2987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number232556
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: