Healthcare Provider Details

I. General information

NPI: 1881215283
Provider Name (Legal Business Name): EMIDIO GERMANO DA SILVA NETO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2020
Last Update Date: 07/27/2021
Certification Date: 07/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GRESHAM DR STE 8620
NORFOLK VA
23507-1904
US

IV. Provider business mailing address

600 GRESHAM DR STE 8620
NORFOLK VA
23507-1904
US

V. Phone/Fax

Practice location:
  • Phone: 757-388-6402
  • Fax:
Mailing address:
  • Phone: 757-388-6402
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0116035063
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: