Provider Demographics
NPI:1063489649
Name:DASILVA, MARCO A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCO
Middle Name:A
Last Name:DASILVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 EXECUTIVE PARK BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-4632
Mailing Address - Country:US
Mailing Address - Phone:423-224-3250
Mailing Address - Fax:423-224-3258
Practice Address - Street 1:4485 W STONE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-1050
Practice Address - Country:US
Practice Address - Phone:423-224-3150
Practice Address - Fax:423-224-3169
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN36826207RH0003X
VA0101237969207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3879352Medicaid
VA010030714Medicaid
VAP00105059Medicare PIN
VA010030714Medicaid
TNP00105059Medicare PIN
TN3879352Medicare PIN
TN103I832937Medicare PIN
VA008536W85Medicare PIN
VAVV1301AMedicare PIN
VAV V1301BMedicare PIN