Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 151698 | NY |
NPI | 1023167020 |
---|---|
Provider Name | Dr. Michael Charles Slaughter |
First Address | Queensbury, NY 12804-1425 |
Second Address | Queensbury, NY 12804-1425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 22/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00747599 | (05) | NY |
03010 | MVP (01) | NY |
10001916 | CDPHP (01) | NY |
11W8136741 | WORKER'S COMP (01) | NY |
B82339 | (02) | NY |