Basic Information
| Provider Information | |||||||||
| NPI: | 1689107849 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THUSHAN N DESILVA MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12446 WEST AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782162517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105251668 | ||||||||
| FaxNumber: | 2105251669 | ||||||||
| Practice Location | |||||||||
| Address1: | 745 W SAN ANTONIO AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BOERNE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780063213 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8303314150 | ||||||||
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| ProviderEnumerationDate: | 04/05/2017 | ||||||||
| LastUpdateDate: | 04/05/2017 | ||||||||
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| AuthorizedOfficialLastName: | BOWEN | ||||||||
| AuthorizedOfficialFirstName: | JANICE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING SPECIALIST | ||||||||
| AuthorizedOfficialTelephone: | 7132926959 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.