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General NPI Number Information
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NPI Number | 1356097380
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Entity Type | Individual
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Provider Name | RORY SLATTERY PA-C
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Gender | Male
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Dates
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Enumeration Date | 02/28/2022
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 330 POMFRET ST
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City | PUTNAM
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State | CT
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Zip | 06260-3803
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Country | US
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Telephone | 860-928-2736
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Fax |
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Provider Business Mailing Address
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Address Line | 205 VERNON AVE APT 244
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City | VERNON
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State | CT
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Zip | 06066-4352
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Country | US
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Telephone | 413-344-7326
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 5592
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License Number State | CT
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