=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194847103
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NOEL SILAN, DPM, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/03/2007
-----------------------------------------------------
Last Update Date | 08/20/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 138 KAYEN CHANDO ST EXPRESS MED PHARMACY BLDG
-----------------------------------------------------
City | DEDEDO
-----------------------------------------------------
State | GU
-----------------------------------------------------
Zip | 96929
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 671-633-3668
-----------------------------------------------------
Fax | 671-647-0027
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 11741
-----------------------------------------------------
City | TAMUNING
-----------------------------------------------------
State | GU
-----------------------------------------------------
Zip | 96931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 671-633-3668
-----------------------------------------------------
Fax | 671-647-0027
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BILLING SUPERVISOR
-----------------------------------------------------
Name | MRS. CAROLYN MAFNAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 671-646-3855
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 213E00000X
-----------------------------------------------------
Taxonomy Name | Podiatrist
-----------------------------------------------------
License Number | POD000004
-----------------------------------------------------
License Number State | GU
-----------------------------------------------------