Provider Demographics
NPI:1285293597
Name:THE, SELENA S (MD)
Entity type:Individual
Prefix:
First Name:SELENA
Middle Name:S
Last Name:THE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:422 QUEENSWAY DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40502-1009
Mailing Address - Country:US
Mailing Address - Phone:859-230-1264
Mailing Address - Fax:
Practice Address - Street 1:1000 S LIMESTONE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-1702
Practice Address - Country:US
Practice Address - Phone:859-323-5901
Practice Address - Fax:859-323-3040
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY58522207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine