Healthcare Provider Details

I. General information

NPI: 1225037195
Provider Name (Legal Business Name): EDWARD J SILVOY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 X RAY DR SUITE A
GASTONIA NC
28054-7488
US

IV. Provider business mailing address

1010 X RAY DR SUITE A
GASTONIA NC
28054-7488
US

V. Phone/Fax

Practice location:
  • Phone: 704-865-7677
  • Fax: 704-865-0756
Mailing address:
  • Phone: 704-865-7677
  • Fax: 704-865-0756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number22385
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: