Provider Demographics
NPI:1649382144
Name:GEORGE D. SILVER D.P.M. INC.
Entity Type:Organization
Organization Name:GEORGE D. SILVER D.P.M. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:330-922-0114
Mailing Address - Street 1:436 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1302
Mailing Address - Country:US
Mailing Address - Phone:330-922-0114
Mailing Address - Fax:330-922-4202
Practice Address - Street 1:436 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1302
Practice Address - Country:US
Practice Address - Phone:330-922-0114
Practice Address - Fax:330-922-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003143213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2201692Medicaid
OHCJ3521OtherRAILROAD MEDICARE
OH17452991300OtherBWC INDIVIDUAL
OHCJ3521OtherRAILROAD MEDICARE
OHGE9309771Medicare ID - Type UnspecifiedMEDICARE GROUP
OH2201692Medicaid
OHCJ3521OtherRAILROAD MEDICARE
OHMA4021782Medicare ID - Type UnspecifiedMDC INDIVIDUAL