Provider Demographics
NPI:1538202437
Name:SELARU, IULIANA KETA (MD)
Entity type:Individual
Prefix:
First Name:IULIANA
Middle Name:KETA
Last Name:SELARU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7226 LEE DEFOREST DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-3239
Mailing Address - Country:US
Mailing Address - Phone:410-656-2646
Mailing Address - Fax:877-423-3879
Practice Address - Street 1:7226 LEE DEFOREST DR
Practice Address - Street 2:SUITE 206
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3239
Practice Address - Country:US
Practice Address - Phone:410-656-2646
Practice Address - Fax:877-423-3879
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0065430207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
783LMedicare ID - Type Unspecified
MD1588074645Medicare UPIN