Healthcare Provider Details

I. General information

NPI: 1811954845
Provider Name (Legal Business Name): BROOK ELIZABETH AMUNDSON C SILVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 08/10/2021
Certification Date: 08/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 GREEN VALLEY RD #101
GREENSBORO NC
27408-7014
US

IV. Provider business mailing address

719 GREEN VALLEY RD 101
GREENSBORO NC
27408-7014
US

V. Phone/Fax

Practice location:
  • Phone: 336-370-0277
  • Fax: 336-333-9757
Mailing address:
  • Phone: 336-370-0227
  • Fax: 336-333-9757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberNC200000174
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: