Provider Demographics
NPI:1588646400
Name:SILVA-KHAZAEI, MARIA LOURDERS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:LOURDERS
Last Name:SILVA-KHAZAEI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:812 N WOOD AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-4058
Mailing Address - Country:US
Mailing Address - Phone:908-353-2064
Mailing Address - Fax:908-353-5052
Practice Address - Street 1:812 N WOOD AVE STE 201
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-4058
Practice Address - Country:US
Practice Address - Phone:908-353-2064
Practice Address - Fax:908-353-5052
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-16
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA64906174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH54976Medicare UPIN