Provider Demographics
NPI:1053379107
Name:SELTZER, SAMUEL ERIC (MD)
Entity type:Individual
Prefix:MR
First Name:SAMUEL
Middle Name:ERIC
Last Name:SELTZER
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:PO BOX 896189
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28289-2098
Mailing Address - Country:US
Mailing Address - Phone:843-664-9393
Mailing Address - Fax:
Practice Address - Street 1:400 N CASHUA DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-2098
Practice Address - Country:US
Practice Address - Phone:843-664-9393
Practice Address - Fax:843-664-2460
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14271207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCTL4181Medicaid
SCTL4181Medicaid