Provider Demographics
NPI:1265533426
Name:SILVERT, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SILVERT
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 1:2089 VALE RD
Mailing Address - Street 2:SUITE 25
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-3847
Mailing Address - Country:US
Mailing Address - Phone:510-235-1137
Mailing Address - Fax:
Practice Address - Street 1:2089 VALE RD
Practice Address - Street 2:SUITE 25
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-3847
Practice Address - Country:US
Practice Address - Phone:510-235-1137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG23121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41862Medicare UPIN