Provider Demographics
NPI:1083771588
Name:DESILVERIO, ROBERT VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:VINCENT
Last Name:DESILVERIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1700 BENJAMIN FRANKLIN PKWY
Mailing Address - Street 2:SUITE 2109
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-2735
Mailing Address - Country:US
Mailing Address - Phone:215-636-9005
Mailing Address - Fax:215-636-9017
Practice Address - Street 1:1700 BENJAMIN FRANKLIN PKWY
Practice Address - Street 2:SUITE 2109
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-2735
Practice Address - Country:US
Practice Address - Phone:215-636-9005
Practice Address - Fax:215-636-9017
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD005847E2084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB32784Medicare UPIN