=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043463250
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES W. SELTZER MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2008
-----------------------------------------------------
Last Update Date | 12/01/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1429 WALNUT ST SUITE 1101
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19102-3218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-279-8376
-----------------------------------------------------
Fax | 215-933-5593
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1429 WALNUT ST SUITE 1101
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19102-3218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-279-8376
-----------------------------------------------------
Fax | 215-933-5593
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RB0002X
-----------------------------------------------------
Taxonomy Name | Obesity Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | MD437081
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------