=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649777467
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAUREN SLATTERY MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/09/2018
-----------------------------------------------------
Last Update Date | 05/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16 FAHY ST STE 202
-----------------------------------------------------
City | BELFAST
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04915-6029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-505-4603
-----------------------------------------------------
Fax | 207-560-9916
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16 FAHY ST STE 202
-----------------------------------------------------
City | BELFAST
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04915-6029
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-505-4603
-----------------------------------------------------
Fax | 207-560-9916
-----------------------------------------------------
=====================================================
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 | 11405490-1205
-----------------------------------------------------
License Number State | UT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | MD29359
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 331808
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------