Provider Demographics
NPI:1851307334
Name:SILK CLINIC PC
Entity Type:Organization
Organization Name:SILK CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:E
Authorized Official - Last Name:SILK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-569-9870
Mailing Address - Street 1:1701 WALNUT STREET
Mailing Address - Street 2:8TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103
Mailing Address - Country:US
Mailing Address - Phone:215-569-9870
Mailing Address - Fax:215-569-9874
Practice Address - Street 1:1701 WALNUT STREET
Practice Address - Street 2:8TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103
Practice Address - Country:US
Practice Address - Phone:215-569-9870
Practice Address - Fax:215-569-9874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022761L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007663880004Medicaid
PA01016281Medicare ID - Type Unspecified
PA0007663880004Medicaid