Provider Demographics
NPI:1689133555
Name:SILLER, ALFREDO JR (MD)
Entity type:Individual
Prefix:
First Name:ALFREDO
Middle Name:
Last Name:SILLER
Suffix:JR
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 1:3024 BURNET AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2420
Mailing Address - Country:US
Mailing Address - Phone:513-221-2828
Mailing Address - Fax:513-872-5721
Practice Address - Street 1:3024 BURNET AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2420
Practice Address - Country:US
Practice Address - Phone:513-221-2828
Practice Address - Fax:513-872-5721
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.150933207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program