Provider Demographics
NPI:1639174147
Name:SILVERSTEIN, RICHARD JAY (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAY
Last Name:SILVERSTEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 941
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-0941
Mailing Address - Country:US
Mailing Address - Phone:410-939-2627
Mailing Address - Fax:410-939-4681
Practice Address - Street 1:508 LAFAYETTE STREET
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-2107
Practice Address - Country:US
Practice Address - Phone:410-939-2627
Practice Address - Fax:410-939-4681
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01306213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD291105100Medicaid
MD291105100Medicaid
MD379RMedicare ID - Type Unspecified