Provider Demographics
NPI:1932197811
Name:SILVA, MARYLOU (PAC)
Entity Type:Individual
Prefix:
First Name:MARYLOU
Middle Name:
Last Name:SILVA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:MARYLOU
Other - Middle Name:
Other - Last Name:JOYCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 CATAMORE BLVD
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-1204
Mailing Address - Country:US
Mailing Address - Phone:401-432-2520
Mailing Address - Fax:401-432-2457
Practice Address - Street 1:326 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2740
Practice Address - Country:US
Practice Address - Phone:860-889-8331
Practice Address - Fax:860-892-6926
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPA002352085R0202X
CT3909363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
275938OtherBLUECHIP
9003558OtherRIMEDICALASSISTANCE
9003558OtherRIMEDICALASSISTANCE
979003558Medicare ID - Type Unspecified