Provider Demographics
NPI:1407932635
Name:SILIS, MANNY PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:MANNY
Middle Name:PETER
Last Name:SILIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5115 FRANCONIA ROAD
Mailing Address - Street 2:SUITE G
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310
Mailing Address - Country:US
Mailing Address - Phone:703-922-4222
Mailing Address - Fax:703-922-4253
Practice Address - Street 1:5115 FRANCONIA ROAD
Practice Address - Street 2:SUITE G
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310
Practice Address - Country:US
Practice Address - Phone:703-922-4222
Practice Address - Fax:703-922-4253
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAB101051358207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F93559Medicare UPIN
VA561745-F08Medicare PIN