Provider Demographics
NPI:1760494538
Name:THOMAS, SILBURN WILSON (MD)
Entity Type:Individual
Prefix:DR
First Name:SILBURN
Middle Name:WILSON
Last Name:THOMAS
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 1:288 S HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-2038
Mailing Address - Country:US
Mailing Address - Phone:914-762-8208
Mailing Address - Fax:
Practice Address - Street 1:105 STEVENS AVE
Practice Address - Street 2:SUITE 602
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-2686
Practice Address - Country:US
Practice Address - Phone:914-668-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176335207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BT 2326088OtherTAX ID NUMBER
BT 2326088OtherTAX ID NUMBER
69F941Medicare ID - Type Unspecified