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General NPI Number Information
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NPI Number | 1932475381
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Entity Type | Individual
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Provider Name | MARK ANTHONY SELLMYER M.D.,P.H.D.
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Gender | Male
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 05/29/2018
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Provider Practice Location Address
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Address Line | 3400 SPRUCE ST 1 SILVERSTEIN PAVILLION.
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City | PHILADELPHIA
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State | PA
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Zip | 19104
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Country | US
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Telephone | 617-543-6546
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Fax |
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Provider Business Mailing Address
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Address Line | 3400 SPRUCE ST 1 SILVERSTEIN PAVILLION.
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City | PHILADELPHIA
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State | PA
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Zip | 19104-4206
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Country | US
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Telephone | 617-543-6546
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085N0904X
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Taxonomy Name | Nuclear Radiology Physician
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License Number | MD452997
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License Number State | PA
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