MEDICARE: DR. SILBURN WILSON THOMAS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	176335	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BT 2326088	OTHER		TAX ID NUMBER

General Provider Information

NPI Number	:	1760494538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SILBURN WILSON THOMAS M.D.

Provider Business Mailing Address
First Line	:	288 S HIGHLAND AVE
Second Line	:
City	:	BRIARCLIFF MANOR
State	:	NY
Zip	:	10510-2038
Country	:	US
Telephone Number	:	914-762-8208
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 STEVENS AVE
Second Line	:	SUITE 602
City	:	MOUNT VERNON
State	:	NY
Zip	:	10550-2686
Country	:	US
Telephone Number	:	914-668-1212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	07/08/2007

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