Healthcare Provider Details

I. General information

NPI: 1851363584
Provider Name (Legal Business Name): ALISON SELBST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 06/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 W CHELTENHAM AVE
ELKINS PARK PA
19027-1046
US

IV. Provider business mailing address

1939 W CHELTENHAM AVE
ELKINS PARK PA
19027-1046
US

V. Phone/Fax

Practice location:
  • Phone: 215-884-5715
  • Fax: 215-884-1442
Mailing address:
  • Phone: 215-884-5715
  • Fax: 215-884-1442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD031264E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: