Healthcare Provider Details

I. General information

NPI: 1457314213
Provider Name (Legal Business Name): CHRISTOPHER LEE SLOCUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2006
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1906 BELLEVIEW AVE SE 13 WEST, PEDIATRIX GROUP
ROANOKE VA
24014-1838
US

IV. Provider business mailing address

1906 BELLEVIEW AVE SE 13 WEST, PEDIATRIX GROUP
ROANOKE VA
24014-1838
US

V. Phone/Fax

Practice location:
  • Phone: 540-266-6012
  • Fax: 540-982-3687
Mailing address:
  • Phone: 540-266-6012
  • Fax: 540-982-3687

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101241839
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number0101241839
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: