Provider Demographics
NPI:1487197257
Name:D'SILVA, ROMA R (MD)
Entity Type:Individual
Prefix:DR
First Name:ROMA
Middle Name:R
Last Name:D'SILVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ROMA
Other - Middle Name:R
Other - Last Name:DSILVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:608 SOUTH NOAH TERRACE
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056
Mailing Address - Country:US
Mailing Address - Phone:847-640-1352
Mailing Address - Fax:
Practice Address - Street 1:608 SOUTH NOAH TERRACE
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056
Practice Address - Country:US
Practice Address - Phone:847-640-1352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0-662-507-3208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice