Healthcare Provider Details

I. General information

NPI: 1922000769
Provider Name (Legal Business Name): GEORGE JOSEPH SILVA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 10/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 INDUSTRIAL DR SUITE 100
MASHPEE MA
02649-3464
US

IV. Provider business mailing address

5 INDUSTRIAL DR SUITE 100
MASHPEE MA
02649-3464
US

V. Phone/Fax

Practice location:
  • Phone: 508-477-4282
  • Fax: 508-539-6134
Mailing address:
  • Phone: 508-477-4282
  • Fax: 508-539-6134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number51965
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: