Healthcare Provider Details

I. General information

NPI: 1679756761
Provider Name (Legal Business Name): RICHARD J. SILVERSTEIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 12/14/2021
Certification Date: 12/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 LAFAYETTE STREET
HAVRE DE GRACE MD
21078-2107
US

IV. Provider business mailing address

PO BOX 941
HAVRE DE GRACE MD
21078
US

V. Phone/Fax

Practice location:
  • Phone: 410-939-2627
  • Fax: 410-939-4681
Mailing address:
  • Phone: 410-939-2627
  • Fax: 410-939-4681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: RICHARD J SILVERSTEIN
Title or Position: OWNER
Credential: D.P.M.
Phone: 410-939-2627