Provider Demographics
NPI:1811918618
Name:SILVIS, TIMOTHY ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ROBERT
Last Name:SILVIS
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 1:24 BATTLE ST
Mailing Address - Street 2:P.O. BOX 302
Mailing Address - City:SOMERS
Mailing Address - State:CT
Mailing Address - Zip Code:06071-1629
Mailing Address - Country:US
Mailing Address - Phone:860-763-4024
Mailing Address - Fax:860-763-4025
Practice Address - Street 1:24 BATTLE ST
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:CT
Practice Address - Zip Code:06071-1629
Practice Address - Country:US
Practice Address - Phone:860-763-4024
Practice Address - Fax:860-763-4025
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT24903207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001249037Medicaid
CT001249037Medicaid
E53401Medicare UPIN