Basic Information
| Provider Information | |||||||||
| NPI: | 1871016857 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SELLMAN | ||||||||
| FirstName: | ANDREA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6701 N CHARLES ST | ||||||||
| Address2: | # 4226 | ||||||||
| City: | TOWSON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212046808 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 9000 FRANKLIN SQUARE DR | ||||||||
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| City: | ROSEDALE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212373901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4437777000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2017 | ||||||||
| LastUpdateDate: | 08/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | R181196 | MD | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | R181196 | MD | N | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.