1477544674 NPI number — DR. LAWRENCE S SLOTNICK MD

Table of content: DR. LAWRENCE S SLOTNICK MD (NPI 1477544674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477544674 NPI number — DR. LAWRENCE S SLOTNICK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SLOTNICK
Provider First Name:
LAWRENCE
Provider Middle Name:
S
Provider Name Prefix Text:
DR.
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:
1477544674
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:
401 W DECATUR ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27025-1913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-548-9618
Provider Business Mailing Address Fax Number:
336-445-2227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 W DECATUR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27025-1913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-548-9618
Provider Business Practice Location Address Fax Number:
336-445-2227
Provider Enumeration Date:
11/04/2005

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: 207RP1001X , with the licence number:  21720 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 77075 . This is a "BCBS OF NC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3683 . This is a "PARTNERS MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: C3857 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8977075 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4800239 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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