1699707372 NPI number — DR. MELVIN J SILVERSTEIN MD

Table of content: DR. MELVIN J SILVERSTEIN MD (NPI 1699707372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699707372 NPI number — DR. MELVIN J SILVERSTEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SILVERSTEIN
Provider First Name:
MELVIN
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699707372
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3334 E COAST HWY
Provider Second Line Business Mailing Address:
#363
Provider Business Mailing Address City Name:
CORONA DEL MAR
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92625-2328
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-488-9510
Provider Business Mailing Address Fax Number:
949-764-8236

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE HOAG DRIVE
Provider Second Line Business Practice Location Address:
HOAG HOSPITAL
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92658-6100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-488-9510
Provider Business Practice Location Address Fax Number:
949-764-8236
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  A41853 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086X0206X , with the licence number: G23100 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G231000 . This is a "BLUE SHIELD PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00G231000 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00G231000C29 . This is a "CAL OPTIMA PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 020039593 . This is a "MEDICARE RAILROAD PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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