Provider Demographics
NPI:1467494401
Name:DESILVA, BRAD WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:WILLIAM
Last Name:DESILVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-2594
Mailing Address - Fax:614-293-4487
Practice Address - Street 1:915 OLENTANGY RIVER RD STE 4000
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-3154
Practice Address - Country:US
Practice Address - Phone:614-366-3687
Practice Address - Fax:614-293-9698
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35087448207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2641618Medicaid
OHDE4234831Medicare PIN