Provider Demographics
NPI:1063487668
Name:SILVA, ERNEST JR (PA)
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:
Last Name:SILVA
Suffix:JR
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 PINE ST
Mailing Address - Street 2:PO BOX 626
Mailing Address - City:NORTH DIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02764-0626
Mailing Address - Country:US
Mailing Address - Phone:508-669-5529
Mailing Address - Fax:
Practice Address - Street 1:175 FALCON DR
Practice Address - Street 2:104TH MEDICAL GROUP - BARNES ANGB
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-1482
Practice Address - Country:US
Practice Address - Phone:413-568-9151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA718363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAP 2636Medicare PIN