Provider Demographics
NPI:1275308439
Name:SILVERSTEIN, MICHAEL ROLAND
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ROLAND
Last Name:SILVERSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16235 NW CANTON ST APT 303
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-1258
Mailing Address - Country:US
Mailing Address - Phone:503-689-2489
Mailing Address - Fax:
Practice Address - Street 1:16235 NW CANTON ST APT 303
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-1258
Practice Address - Country:US
Practice Address - Phone:503-689-2489
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-17
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10225244133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered