Provider Demographics
NPI:1346295672
Name:SILVA, KATHRYN NOVELLO (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:NOVELLO
Last Name:SILVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:ANN
Other - Last Name:NOVELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 64442
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4442
Mailing Address - Country:US
Mailing Address - Phone:410-328-7604
Mailing Address - Fax:410-328-7607
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-7604
Practice Address - Fax:410-328-7607
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2013-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD61653207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405384200Medicaid
MD643052-01OtherBLUE SHIELD
MDS062-0242OtherBLUE CHOICE
MDJ493Medicare PIN
MDP00166611Medicare PIN
MD643052-01OtherBLUE SHIELD