Healthcare Provider Details

I. General information

NPI: 1518963735
Provider Name (Legal Business Name): BRUCE A SILVERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 HOUNSLOW DR
MANAKIN SABOT VA
23103-2270
US

IV. Provider business mailing address

1340 HOUNSLOW DR
MANAKIN SABOT VA
23103-2270
US

V. Phone/Fax

Practice location:
  • Phone: 804-536-1469
  • Fax:
Mailing address:
  • Phone: 804-536-1469
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0101038212
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: