Basic Information
| Provider Information | |||||||||
| NPI: | 1457395527 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SELIM | ||||||||
| FirstName: | ALFREDO | ||||||||
| MiddleName: | JESUS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1611 CAMBRIDGE STREET | ||||||||
| Address2: | INTERNAL MEDICINE | ||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176615100 | ||||||||
| FaxNumber: | 6176615226 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 VFW PKWY | ||||||||
| Address2: | |||||||||
| City: | WEST ROXBURY | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021324927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6173237700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 11/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 76321 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207P00000X | 76321 | MA | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 6000154 | 01 | MA | HARVARD PILGRIM | OTHER | 076321 | 01 | MA | TUFTS | OTHER | 0030512 | 01 | MA | NEIGHBORHOOD HEALTH | OTHER | J26489 | 01 | MA | BLUE CROSS | OTHER | 2015170 | 05 | MA | MEDICAID |