Provider Demographics
NPI:1730177635
Name:SILVERBERG, LARRY F (MD)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:F
Last Name:SILVERBERG
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 1:1401 AVOCADO AVE
Mailing Address - Street 2:SUITE 703
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7720
Mailing Address - Country:US
Mailing Address - Phone:949-760-0190
Mailing Address - Fax:949-760-0439
Practice Address - Street 1:1401 AVOCADO AVE
Practice Address - Street 2:SUITE 703
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7720
Practice Address - Country:US
Practice Address - Phone:949-760-0190
Practice Address - Fax:949-760-0439
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40895207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A48391Medicare UPIN
640895Medicare ID - Type Unspecified