Provider Demographics
NPI:1063489649
Name:DASILVA, MARCO A (MD)
Entity type:Individual
Prefix:DR
First Name:MARCO
Middle Name:A
Last Name:DASILVA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 W OAKLAND AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2192
Mailing Address - Country:US
Mailing Address - Phone:423-302-6565
Mailing Address - Fax:
Practice Address - Street 1:2202 N JOHN B DENNIS HWY STE 100
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-5904
Practice Address - Country:US
Practice Address - Phone:423-578-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237969207RH0003X
TN36826207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010030714Medicaid
TN3879352Medicaid
VAP00105059Medicare PIN
VA010030714Medicaid
TNP00105059Medicare PIN
TN3879352Medicare PIN
TN103I832937Medicare PIN
VA008536W85Medicare PIN
VAVV1301AMedicare PIN
VAV V1301BMedicare PIN