Healthcare Provider Details

I. General information

NPI: 1487180436
Provider Name (Legal Business Name): SILVERSAGE PHYSICIAN SERVICES OF VIRGINIA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2017
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 NORTHWEST DR
CHARLOTTESVILLE VA
22901-2309
US

IV. Provider business mailing address

PO BOX 23213
CHATTANOOGA TN
37422-3213
US

V. Phone/Fax

Practice location:
  • Phone: 434-973-7933
  • Fax:
Mailing address:
  • Phone: 423-815-1600
  • Fax: 423-763-1118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN M. EVANS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 423-815-1600