Healthcare Provider Details

I. General information

NPI: 1548493406
Provider Name (Legal Business Name): MARC L SLATKOFF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2009
Last Update Date: 02/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 PINEVIEW DR
KERNERSVILLE NC
27284-3817
US

IV. Provider business mailing address

PO BOX 75216
CHARLOTTE NC
28275-0216
US

V. Phone/Fax

Practice location:
  • Phone: 336-277-8800
  • Fax: 336-277-8850
Mailing address:
  • Phone: 336-993-6663
  • Fax: 336-993-7183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number21117
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: