Provider Demographics
NPI:1245225523
Name:SILVA, SAMUEL D (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:D
Last Name:SILVA
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 1:243 CALLE PARIS
Mailing Address - Street 2:SUITE 1834
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00917-3632
Mailing Address - Country:US
Mailing Address - Phone:787-753-2015
Mailing Address - Fax:
Practice Address - Street 1:CALLE AMERICA 151
Practice Address - Street 2:FLORAL PARK, HATO REY
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00917
Practice Address - Country:US
Practice Address - Phone:787-753-2015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR12158207V00000X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR88616Medicare ID - Type Unspecified
PRG-41009Medicare UPIN