Provider Demographics
NPI:1770589871
Name:SYLVA, MICHAEL ANTHONY (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:SYLVA
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 1:8096 EDWIN RAYNOR BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-6837
Mailing Address - Country:US
Mailing Address - Phone:410-255-5525
Mailing Address - Fax:410-255-3323
Practice Address - Street 1:8096 EDWIN RAYNOR BLVD STE D
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-6837
Practice Address - Country:US
Practice Address - Phone:410-255-5525
Practice Address - Fax:410-255-3323
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0034109174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD384P7616Medicare PIN
MDE40544Medicare UPIN