Provider Demographics
NPI:1750321279
Name:SILVA, ROGELIO A (MD)
Entity Type:Individual
Prefix:
First Name:ROGELIO
Middle Name:A
Last Name:SILVA
Suffix:
Gender:M
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:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-688-1330
Mailing Address - Fax:270-688-1338
Practice Address - Street 1:1200 BARRET BLVD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-4950
Practice Address - Country:US
Practice Address - Phone:270-844-8600
Practice Address - Fax:270-844-8610
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060171A2084P0800X
KY210732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000379571OtherANTHEM PIN
IN200520440Medicaid
KY64210735Medicaid
KY260048298OtherRAILROAD MEDICARE
IN200520440Medicaid
IN145790AAMedicare ID - Type Unspecified
KY64210735Medicaid
IN247890KMedicare PIN
IN200520440Medicaid
IL$$$$$$$$$Medicaid