MEDICARE: MR. MARK VICENTE SILVA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	208800000X	Urology Physician	D0082958	MD

General Provider Information

NPI Number	:	1508158718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK VICENTE SILVA M.D.

Provider Business Mailing Address
First Line	:	25 CROSSROADS DR STE 306
Second Line	:
City	:	OWINGS MILLS
State	:	MD
Zip	:	21117-5437
Country	:	US
Telephone Number	:	443-738-2872
Fax Number	:

Provider Business Practice Location Address
First Line	:	7580 BUCKINGHAM BLVD STE 110
Second Line	:
City	:	HANOVER
State	:	MD
Zip	:	21076-3208
Country	:	US
Telephone Number	:	410-581-1600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2011
Last Update Date	:	04/07/2022

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