Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 212331 | MA |
NPI | 1023040565 |
---|---|
Provider Name | Thomas K Slack |
First Address | Wellfleet, MA 02667-8504 |
Second Address | Wellfleet, MA 02667-8504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 24/11/2009 |