Basic Information
| Provider Information | |||||||||
| NPI: | 1326209867 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SILVEY | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2875 W MARKET ST | ||||||||
| Address2: | |||||||||
| City: | FAIRLAWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443334064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308656530 | ||||||||
| FaxNumber: | 2343122305 | ||||||||
| Practice Location | |||||||||
| Address1: | 2875 W MARKET ST | ||||||||
| Address2: | |||||||||
| City: | FAIRLAWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443334064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308656530 | ||||||||
| FaxNumber: | 2343172305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2008 | ||||||||
| LastUpdateDate: | 06/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35092989 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2923779 | 05 | OH | MEDICAID |