Provider Demographics
NPI:1770557860
Name:SILVERIO, CARL A (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:A
Last Name:SILVERIO
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 1:155 CRYSTAL RUN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-4028
Mailing Address - Country:US
Mailing Address - Phone:845-703-3608
Mailing Address - Fax:845-703-6297
Practice Address - Street 1:155 CRYSTAL RUN RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10941-4028
Practice Address - Country:US
Practice Address - Phone:845-703-3608
Practice Address - Fax:845-703-6297
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2179442085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02109864Medicaid
NY979774T771Medicare PIN
NYA400034749Medicare PIN
NYA400060278Medicare PIN
NY02109864Medicaid
NY300118217Medicare PIN
H28626Medicare UPIN
NY9797732722Medicare PIN