Provider Demographics
NPI:1508066275
Name:TODD B. SILVERMAN, M.D., PC
Entity Type:Organization
Organization Name:TODD B. SILVERMAN, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOEDEKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-996-8830
Mailing Address - Street 1:969 N. MASON RD.
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141
Mailing Address - Country:US
Mailing Address - Phone:314-996-8830
Mailing Address - Fax:314-996-8778
Practice Address - Street 1:969 N MASON RD
Practice Address - Street 2:SUITE 140
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6338
Practice Address - Country:US
Practice Address - Phone:314-996-8830
Practice Address - Fax:314-996-8778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20010122512084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOH83387Medicare UPIN