Healthcare Provider Details

I. General information

NPI: 1023278934
Provider Name (Legal Business Name): ENRIQUE SILBERBLATT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2008
Last Update Date: 06/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 BRAMBLETON AVE
ROANOKE VA
24018-6521
US

IV. Provider business mailing address

3505 BRAMBLETON AVE
ROANOKE VA
24018-6521
US

V. Phone/Fax

Practice location:
  • Phone: 540-776-1600
  • Fax:
Mailing address:
  • Phone: 540-776-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101038211
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: