Healthcare Provider Details

I. General information

NPI: 1104825587
Provider Name (Legal Business Name): MARK J SILVERSMITH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 WASHINGTON PL
BEDFORD NH
03110-6747
US

IV. Provider business mailing address

11 WASHINGTON PL
BEDFORD NH
03110-6747
US

V. Phone/Fax

Practice location:
  • Phone: 603-624-4450
  • Fax: 603-606-3049
Mailing address:
  • Phone: 603-624-4450
  • Fax: 603-606-3049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number8633
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: