1245231265 NPI number — MR. CHARLES E SLOANE MD

Table of content: LAUREN ACEVEDO-MOLINA MD (NPI 1316333669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245231265 NPI number — MR. CHARLES E SLOANE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLOANE
Provider First Name:
CHARLES
Provider Middle Name:
E
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245231265
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 850
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WORTHINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16262-0850
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-543-3663
Provider Business Mailing Address Fax Number:
724-545-6905

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 PARKVIEW DR
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
KITTANNING
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16201-7138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-645-3663
Provider Business Practice Location Address Fax Number:
724-545-6905
Provider Enumeration Date:
08/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  023414E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 20476 . This is a "HEALTH ASSURANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20476 . This is a "HEALTH AMERICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 250482 . This is a "UPMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1367605 . This is a "UMW" identifier . This identifiers is of the category "OTHER".
  • Identifier: P020162 . This is a "CHAMPUS" identifier . This identifiers is of the category "OTHER".




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