Basic Information
| Provider Information | |||||||||
| NPI: | 1013978030 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SILVA | ||||||||
| FirstName: | JORGE | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 354 BIRNIE AVE | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011071108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137333470 | ||||||||
| FaxNumber: | 4137335235 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 COLLEGE HWY | ||||||||
| Address2: | |||||||||
| City: | SOUTHWICK | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010779690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135692257 | ||||||||
| FaxNumber: | 4135692264 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2006 | ||||||||
| LastUpdateDate: | 04/05/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | 40722 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | E05209 | 01 | MA | BCBS | OTHER | 110000496B | 05 | MA | MEDICAID |