Healthcare Provider Details

I. General information

NPI: 1699729996
Provider Name (Legal Business Name): PHILLIP SILVERSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 03/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 I ST
LOS BANOS CA
93635-4211
US

IV. Provider business mailing address

940 14TH ST
PACIFIC GROVE CA
93950-4902
US

V. Phone/Fax

Practice location:
  • Phone: 209-826-0591
  • Fax:
Mailing address:
  • Phone: 610-331-7963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC53038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: