Provider Demographics
NPI:1366733305
Name:SELAK, MONICA ANN (MD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:ANN
Last Name:SELAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:864 BLACK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FOUR OAKS
Mailing Address - State:NC
Mailing Address - Zip Code:27524-8314
Mailing Address - Country:US
Mailing Address - Phone:919-963-3148
Mailing Address - Fax:919-963-2900
Practice Address - Street 1:864 BLACK CREEK RD
Practice Address - Street 2:
Practice Address - City:FOUR OAKS
Practice Address - State:NC
Practice Address - Zip Code:27524-8314
Practice Address - Country:US
Practice Address - Phone:919-963-3148
Practice Address - Fax:919-963-2900
Is Sole Proprietor?:No
Enumeration Date:2011-04-26
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2014-00923207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCK949BMedicare PIN