Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 11257 | NH |
NPI | 1265455281 |
---|---|
Provider Name | Mark B Silbey |
First Address | Keene, NH 03431-1719 |
Second Address | Keene, NH 03431-1719 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 02/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30201503 | (05) | NH |
F34418 | (02) |