Healthcare Provider Details

I. General information

NPI: 1356097380
Provider Name (Legal Business Name): RORY SLATTERY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2022
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 POMFRET ST
PUTNAM CT
06260-3803
US

IV. Provider business mailing address

205 VERNON AVE APT 244
VERNON CT
06066-4352
US

V. Phone/Fax

Practice location:
  • Phone: 860-928-2736
  • Fax:
Mailing address:
  • Phone: 413-344-7326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5592
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: