Provider Demographics
NPI:1326111311
Name:SILVAGNOLI, LOUIS JR (MD)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:
Last Name:SILVAGNOLI
Suffix:JR
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 1:720 HARRISON AVE
Mailing Address - Street 2:DOB 503
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2371
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:900 WASHINGTON ST
Practice Address - Street 2:SUITE C
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3498
Practice Address - Country:US
Practice Address - Phone:617-414-9400
Practice Address - Fax:781-762-2677
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45543207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAC03049OtherBCBS
110137853OtherRR MEDICARE
RI4761-2OtherBCBS
MA04-02032OtherUNITED HEALTHCARE
MA045543OtherTUFTS HEALTHPLAN
MA61166OtherHARVARD PILGRIM
MA110006757AMedicaid
MA0022872OtherNEIGHBORHOOD HEALTHPLAN
MA045543OtherTUFTS HEALTHPLAN
MAC03049Medicare PIN