Provider Demographics
NPI:1104825587
Name:SILVERSMITH, MARK J (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:SILVERSMITH
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 1:11 WASHINGTON PL
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6747
Mailing Address - Country:US
Mailing Address - Phone:603-624-4450
Mailing Address - Fax:603-606-3049
Practice Address - Street 1:11 WASHINGTON PL
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6747
Practice Address - Country:US
Practice Address - Phone:603-624-4450
Practice Address - Fax:603-606-3049
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8633207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30004816Medicaid
NHRE1901Medicare PIN
NHD91819Medicare UPIN