Provider Demographics
NPI:1780679118
Name:LIJOI, SILVESTRO J (DO)
Entity Type:Individual
Prefix:
First Name:SILVESTRO
Middle Name:J
Last Name:LIJOI
Suffix:
Gender:M
Credentials:DO
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 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1114 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-7326
Practice Address - Country:US
Practice Address - Phone:843-212-8070
Practice Address - Fax:843-212-8071
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-00071207P00000X, 207Q00000X
VA0102201388207Q00000X
SC1545207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1545OtherSC MEDICAL LICENSE
NC5905797Medicaid
SC015450Medicaid
VA010069777Medicaid
NC2062758FMedicare PIN
NC2062758SMedicare PIN
NC2062758BMedicare PIN
NCNC3775EMedicare UPIN
NCNC3775AMedicare PIN
NC2062758CMedicare PIN
NC2062758NMedicare PIN
NC2062758AMedicare PIN
NC2062758Medicare ID - Type Unspecified
NC2062758WMedicare PIN
NCP00423404Medicare PIN
NC2062758JMedicare PIN
NC2062758GMedicare PIN
NC2062758HMedicare PIN
NC2062758LMedicare PIN
VA00V945T01Medicare ID - Type Unspecified
NC2062758KMedicare PIN
NC2062758EMedicare PIN
NC2062758DMedicare PIN