MEDICARE: GREGORY D SLICK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD027746E	PA

General Provider Information

NPI Number	:	1326032541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY D SLICK MD

Provider Business Mailing Address
First Line	:	1086 FRANKLIN ST
Second Line	:
City	:	JOHNSTOWN
State	:	PA
Zip	:	15905-4305
Country	:	US
Telephone Number	:	814-535-8885
Fax Number	:	814-535-8720

Provider Business Practice Location Address
First Line	:	140 S ANDERSON ST
Second Line	:
City	:	BEDFORD
State	:	PA
Zip	:	15522-1403
Country	:	US
Telephone Number	:	814-623-6917
Fax Number	:	814-623-7520

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2005
Last Update Date	:	07/08/2007

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