Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YP0228X | Pediatric Otolaryngology | 0101229009 | VA |
N | 207YP0228X | Pediatric Otolaryngology | D0080294 | MD |
NPI | 1972569192 |
---|---|
Provider Name | Andrew Benedict Silva |
First Address | Lansdowne, VA 20176-8102 |
Second Address | Lansdowne, VA 20176-8102 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 21/04/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
188793 | BLUE CROSS BLUE SHIELD (01) | VA |
1972569192 | (05) | VA |
H29310 | (02) | VA |
P00406812 | RR MEDICARE (01) | VA |