Provider Demographics
NPI:1972620854
Name:SILVERMAN, MARK LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:LAWRENCE
Last Name:SILVERMAN
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 1:1019 HAYNES ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-6779
Mailing Address - Country:US
Mailing Address - Phone:248-647-0391
Mailing Address - Fax:248-647-9142
Practice Address - Street 1:1019 HAYNES ST
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6779
Practice Address - Country:US
Practice Address - Phone:248-647-0391
Practice Address - Fax:248-647-9142
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010551652084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI172714OtherCOMPSYCH PROVIDER #
38-3309235OtherTAX ID #
BS 8603791OtherDEA NUMBER
BS 8603791OtherDEA NUMBER
MIMI6868001Medicare PIN