Healthcare Provider Details

I. General information

NPI: 1972569192
Provider Name (Legal Business Name): ANDREW BENEDICT SILVA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19455 DEERFIELD AVENUE SUITE 301
LANSDOWNE VA
20176-8102
US

IV. Provider business mailing address

19455 DEERFIELD AVENUE SUITE 301
LANSDOWNE VA
20176-8102
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-4439
  • Fax: 703-858-4489
Mailing address:
  • Phone: 703-858-4439
  • Fax: 703-858-4489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number0101229009
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License NumberD0080294
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: