Provider Demographics
NPI:1952545840
Name:SILVA, LOURDES G (DO)
Entity Type:Individual
Prefix:
First Name:LOURDES
Middle Name:G
Last Name:SILVA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:137 PROSPECT ST
Practice Address - Street 2:SUITE 102
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-1712
Practice Address - Country:US
Practice Address - Phone:973-344-5379
Practice Address - Fax:973-344-1988
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY253028207R00000X
NJ25MB09397600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program