Provider Demographics
NPI:1821183302
Name:DESILVA, GINIGE SWANTHRI (MD)
Entity Type:Individual
Prefix:DR
First Name:GINIGE
Middle Name:SWANTHRI
Last Name:DESILVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5100 SEMINOLE BLVD
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33708-3354
Mailing Address - Country:US
Mailing Address - Phone:727-319-4535
Mailing Address - Fax:727-319-4528
Practice Address - Street 1:5100 SEMINOLE BLVD
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33708-3354
Practice Address - Country:US
Practice Address - Phone:727-319-4535
Practice Address - Fax:727-319-4528
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91341207R00000X, 207RA0201X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI27527Medicare UPIN
FLU4487ZMedicare PIN