Provider Demographics
NPI:1942315569
Name:SILVA LOPEZ, EDIBALDO (MD)
Entity type:Individual
Prefix:
First Name:EDIBALDO
Middle Name:
Last Name:SILVA LOPEZ
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 1:13900 CHURCH HILL DR
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-2131
Mailing Address - Country:US
Mailing Address - Phone:703-335-2779
Mailing Address - Fax:
Practice Address - Street 1:13900 CHURCH HILL DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-2131
Practice Address - Country:US
Practice Address - Phone:703-335-2779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE225372086X0206X
VA01012754562086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE098605091Medicare PIN
NEP00678956Medicare UPIN
NE276857Medicare PIN
NEP00049649Medicare PIN