Healthcare Provider Details

I. General information

NPI: 1871016857
Provider Name (Legal Business Name): ANDREA SELLMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2017
Last Update Date: 08/10/2020
Certification Date: 08/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 FRANKLIN SQUARE DR
ROSEDALE MD
21237-3901
US

IV. Provider business mailing address

6701 N CHARLES ST # 4226
TOWSON MD
21204-6808
US

V. Phone/Fax

Practice location:
  • Phone: 443-777-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR181196
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberR181196
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: