Healthcare Provider Details

I. General information

NPI: 1194709493
Provider Name (Legal Business Name): ANGELINA MARIE COLTON-SLOTTER DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELINA MARIE COLTON DPM

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 N OLD TRL STE A
SHAMOKIN DAM PA
17876-9428
US

IV. Provider business mailing address

3120 N OLD TRL STE A
SHAMOKIN DAM PA
17876-9428
US

V. Phone/Fax

Practice location:
  • Phone: 570-374-3668
  • Fax: 570-374-7306
Mailing address:
  • Phone: 570-374-3668
  • Fax: 570-374-7306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC004206R
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: