Healthcare Provider Details

I. General information

NPI: 1962424879
Provider Name (Legal Business Name): SHERI S. SLEZAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 03/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

PO BOX 64226
BALTIMORE MD
21264-4742
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-6897
  • Fax: 410-328-2109
Mailing address:
  • Phone: 410-328-6897
  • Fax: 410-328-2109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD32924
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: