Provider Demographics
NPI:1992822704
Name:SILVER, JEROME DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:DAVID
Last Name:SILVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3850 SHORE DR
Mailing Address - Street 2:SUITE #300
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-5621
Mailing Address - Country:US
Mailing Address - Phone:317-290-0600
Mailing Address - Fax:317-290-1426
Practice Address - Street 1:3850 SHORE DR
Practice Address - Street 2:SUITE #300
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-5621
Practice Address - Country:US
Practice Address - Phone:317-290-0600
Practice Address - Fax:317-290-1426
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037365207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN332160Medicare ID - Type Unspecified
INB47486Medicare UPIN