Provider Demographics
NPI:1184687576
Name:SILKES, DEBRA S (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:S
Last Name:SILKES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1601
Mailing Address - Country:US
Mailing Address - Phone:570-723-0716
Mailing Address - Fax:570-723-0638
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:
Practice Address - City:WELLSBORO
Practice Address - State:PA
Practice Address - Zip Code:16901-1601
Practice Address - Country:US
Practice Address - Phone:570-723-0716
Practice Address - Fax:570-723-0638
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD063411L208600000X
NY175014208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY103668FLOtherPREFERRED CARE
NY1709681OtherINDEPEND HEALTH
NY9120335OtherPHCS
NY100899OtherGHI LAKE PLAINS
NY005249655OtherBLUE CROSS WNY
NYP010175014OtherBLUE CROSS ROCHESTER
NY00010313703OtherUNIVERA
NY9120335OtherPHCS
CC0421Medicare ID - Type Unspecified