Healthcare Provider Details

I. General information

NPI: 1811052079
Provider Name (Legal Business Name): VALERIE BETH SELIGSON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 CHARTER DR SUITE 140
COLUMBIA MD
21044-3629
US

IV. Provider business mailing address

PO BOX 64481
BALTIMORE MD
21264-4481
US

V. Phone/Fax

Practice location:
  • Phone: 301-908-2676
  • Fax: 410-910-2393
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618000280
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0601001213
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA0895
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: