Healthcare Provider Details

I. General information

NPI: 1154366425
Provider Name (Legal Business Name): WALTER SLOWINSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 MAIN ST
PUTNEY VT
05346-8701
US

IV. Provider business mailing address

PO BOX 247 126 MAIN STREET
PUTNEY VT
05346-0247
US

V. Phone/Fax

Practice location:
  • Phone: 802-387-5581
  • Fax: 802-387-6694
Mailing address:
  • Phone: 802-387-5581
  • Fax: 802-387-6694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0420009665
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: