Healthcare Provider Details

I. General information

NPI: 1083771588
Provider Name (Legal Business Name): ROBERT VINCENT DESILVERIO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 BENJAMIN FRANKLIN PKWY SUITE 2109
PHILADELPHIA PA
19103-2735
US

IV. Provider business mailing address

1700 BENJAMIN FRANKLIN PKWY SUITE 2109
PHILADELPHIA PA
19103-2735
US

V. Phone/Fax

Practice location:
  • Phone: 215-636-9005
  • Fax: 215-636-9017
Mailing address:
  • Phone: 215-636-9005
  • Fax: 215-636-9017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License NumberMD005847E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: