Healthcare Provider Details

I. General information

NPI: 1265351019
Provider Name (Legal Business Name): MARK SILVIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W SILVER ST FL 2
MIDDLETOWN CT
06457-3831
US

IV. Provider business mailing address

30 W SILVER ST FL 2
MIDDLETOWN CT
06457-3831
US

V. Phone/Fax

Practice location:
  • Phone: 860-986-4495
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: