Provider Demographics
NPI:1992323877
Name:SILVA, ANDRE R (PRACTITIONER)
Entity type:Individual
Prefix:MR
First Name:ANDRE
Middle Name:R
Last Name:SILVA
Suffix:
Gender:M
Credentials:PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 NEWBURY ST STE 31
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2872
Mailing Address - Country:US
Mailing Address - Phone:617-785-6837
Mailing Address - Fax:
Practice Address - Street 1:176 NEWBURY ST STE 31
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2872
Practice Address - Country:US
Practice Address - Phone:617-785-6837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MABAP-2020-00168247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other