=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245231265
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLES E SLOANE MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 PARKVIEW DR STE 2
-----------------------------------------------------
City | KITTANNING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16201-7138
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-645-3663
-----------------------------------------------------
Fax | 724-545-6905
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 850
-----------------------------------------------------
City | WORTHINGTON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 16262-0850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-543-3663
-----------------------------------------------------
Fax | 724-545-6905
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 023414E
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------