Healthcare Provider Details

I. General information

NPI: 1821080748
Provider Name (Legal Business Name): TODD D SLATER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 10/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1487 N HIGH ST SUITE 102
HILLSBORO OH
45133-8496
US

IV. Provider business mailing address

PO BOX 637736
CINCINNATI OH
45263-7736
US

V. Phone/Fax

Practice location:
  • Phone: 937-393-3406
  • Fax: 937-393-0511
Mailing address:
  • Phone: 513-891-1006
  • Fax: 513-793-1032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35-050621
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: