Basic Information
| Provider Information | |||||||||
| NPI: | 1356385462 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SILVERNAIL | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | LOUIS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 751069 | ||||||||
| Address2: | ECU PHYSICIANS | ||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282751069 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | PITT COUNTY HEALTH DEPARTMENT | ||||||||
| Address2: | 201 GOVERNMENT CIRCLE | ||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278347503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2529022300 | ||||||||
| FaxNumber: | 2524131396 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 07/30/2019 | ||||||||
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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 | 207Q00000X | 196713 | NY | N | Allopathic & Osteopathic Physicians | Family Medicine | 2083X0100X | 2012-01580 | NC | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Occupational Medicine | 2083P0901X | 2012-01580 | NC | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine |
ID Information
| ID | Type | State | Issuer | Description | 173GE | 01 | NC | BCBSNC | OTHER | 5921388 | 05 | NC | MEDICAID | 01507973 | 05 | NY | MEDICAID |