Healthcare Provider Details

I. General information

NPI: 1790313500
Provider Name (Legal Business Name): POOJA SELVAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2020
Last Update Date: 07/17/2023
Certification Date: 07/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CENTENNIAL BLVD BLDG 2
VOORHEES NJ
08043-4637
US

IV. Provider business mailing address

1 FEDERAL ST # 200
CAMDEN NJ
08103-1088
US

V. Phone/Fax

Practice location:
  • Phone: 856-325-6770
  • Fax: 856-352-6777
Mailing address:
  • Phone: 848-288-6935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA11818300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: