Provider Demographics
NPI:1740332980
Name:SILVA, WALDEMAR EMILIO (MD)
Entity type:Individual
Prefix:DR
First Name:WALDEMAR
Middle Name:EMILIO
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 1:32 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07522-1775
Mailing Address - Country:US
Mailing Address - Phone:973-790-6594
Mailing Address - Fax:973-389-2683
Practice Address - Street 1:32 CLINTON ST
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07522-1775
Practice Address - Country:US
Practice Address - Phone:973-790-6594
Practice Address - Fax:973-389-2683
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2022-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04663100207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0769207Medicaid
D18861Medicare UPIN
NJ446490Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER