Provider Demographics
NPI:1245287846
Name:SILVERBACH, SPENCER (MD)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:SILVERBACH
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 1:1516 COTNER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-3303
Mailing Address - Country:US
Mailing Address - Phone:310-445-2951
Mailing Address - Fax:310-479-1459
Practice Address - Street 1:1516 COTNER AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-3303
Practice Address - Country:US
Practice Address - Phone:310-445-2951
Practice Address - Fax:310-479-1459
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG312052085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G312050Medicaid
CA00G312050OtherBLUE SHIELD
CAWG31205AMedicare PIN
CAWG31205CMedicare PIN
CA00G312056Medicare PIN
CAWG31205DMedicare PIN
CA00G3120512Medicare PIN
CA00G312058Medicare PIN
CA00G312050OtherBLUE SHIELD
CA00G312059Medicare PIN
CA00G3120513Medicare PIN
CA00G3120510Medicare PIN
CAA44689Medicare UPIN
CA00G312053Medicare PIN
CAWG31205EMedicare PIN
CA00G312055Medicare PIN
CAWG31205BMedicare PIN
CAWG31205FMedicare PIN
CA00G312054Medicare PIN
CA00G312050Medicaid
CAP00479556Medicare PIN