Provider Demographics
NPI:1679756761
Name:RICHARD J. SILVERSTEIN
Entity Type:Organization
Organization Name:RICHARD J. SILVERSTEIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:SILVERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-939-2627
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
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4165940001Medicare NSC