Provider Demographics
NPI:1457395527
Name:SELIM, ALFREDO JESUS (MD)
Entity type:Individual
Prefix:
First Name:ALFREDO
Middle Name:JESUS
Last Name:SELIM
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 1:1611 CAMBRIDGE STREET
Mailing Address - Street 2:INTERNAL MEDICINE
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138
Mailing Address - Country:US
Mailing Address - Phone:617-661-5100
Mailing Address - Fax:617-661-5226
Practice Address - Street 1:1400 VFW PKWY
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-4927
Practice Address - Country:US
Practice Address - Phone:617-323-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76321207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6000154OtherHARVARD PILGRIM
MA076321OtherTUFTS
MA0030512OtherNEIGHBORHOOD HEALTH
MAJ26489OtherBLUE CROSS
MA2015170Medicaid
MA076321OtherTUFTS
MAA36019Medicare PIN