Healthcare Provider Details

I. General information

NPI: 1912123712
Provider Name (Legal Business Name): MICHAEL A SYLVA MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 10/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8096 EDWIN RAYNOR BLVD STE D
PASADENA MD
21122-6837
US

IV. Provider business mailing address

8096 EDWIN RAYNOR BLVD STE D
PASADENA MD
21122-6837
US

V. Phone/Fax

Practice location:
  • Phone: 410-255-5525
  • Fax: 410-255-3323
Mailing address:
  • Phone: 410-255-5525
  • Fax: 410-255-3323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0034109
License Number StateMD

VIII. Authorized Official

Name: DR. MICHAEL ANTHONY SYLVA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 410-255-5525