Healthcare Provider Details

I. General information

NPI: 1750787743
Provider Name (Legal Business Name): JAMES SLADE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2014
Last Update Date: 11/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 SOUTHBRIDGE ST
AUBURN MA
01501-2498
US

IV. Provider business mailing address

4 HORSESHOE LN
WILBRAHAM MA
01095-1316
US

V. Phone/Fax

Practice location:
  • Phone: 508-832-2020
  • Fax: 401-921-3327
Mailing address:
  • Phone: 413-896-4160
  • Fax: 401-921-3327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number301
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: