Provider Demographics
NPI:1225028285
Name:SILVA, PHAELON H (MD)
Entity Type:Individual
Prefix:DR
First Name:PHAELON
Middle Name:H
Last Name:SILVA
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 1:20 ARROWWOOD DR.
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-266-7800
Mailing Address - Fax:607-216-0093
Practice Address - Street 1:20 ARROWWOOD DR.
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-266-7800
Practice Address - Fax:607-216-0093
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245583207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400075103Medicare PIN
VAD000Medicare UPIN