Provider Demographics
NPI:1861713885
Name:JOHN G SLATTERY MD
Entity type:Organization
Organization Name:JOHN G SLATTERY MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SLATTERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-884-5333
Mailing Address - Street 1:925 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3188
Mailing Address - Country:US
Mailing Address - Phone:401-884-5333
Mailing Address - Fax:401-884-5664
Practice Address - Street 1:925 MAIN STREET
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3188
Practice Address - Country:US
Practice Address - Phone:401-884-5333
Practice Address - Fax:401-884-5664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI 8483261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care