Provider Demographics
NPI:1104945997
Name:SELZNICK, LEE (MD)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:
Last Name:SELZNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 CAMPUS BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2889
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:540-536-0235
Practice Address - Street 1:1818 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2869
Practice Address - Country:US
Practice Address - Phone:540-450-0072
Practice Address - Fax:540-450-0074
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV29697207T00000X
VA0101241479207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA358707OtherANTHEM BCBS
VAP00657226OtherMEDICARE RR
WV3810009350Medicaid
VA1104945997Medicaid
VA1104945997Medicaid
WV3810009350Medicaid