Healthcare Provider Details

I. General information

NPI: 1770003501
Provider Name (Legal Business Name): SAMUEL D. SLAVIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: SAMUEL DENNIS SLAVIN MD

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 ALBANY ST SUITE 7B, SHAPIRO BLDG
BOSTON MA
02118
US

IV. Provider business mailing address

960 MASSACHUSETTS AVENUE FL 2
BOSTON MA
02118
US

V. Phone/Fax

Practice location:
  • Phone: 617-638-7490
  • Fax: 617-648-0515
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number281460
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number281460
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number281460
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: