MEDICARE: DR. NANCY S SLATER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	60370	MA

General Provider Information

NPI Number	:	1104975887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY S SLATER M.D.

Provider Business Mailing Address
First Line	:	48 NORTH ST
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02420-1812
Country	:	US
Telephone Number	:	781-862-7893
Fax Number	:	781-862-7893

Provider Business Practice Location Address
First Line	:	48 NORTH ST
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02420-1812
Country	:	US
Telephone Number	:	781-862-7893
Fax Number	:	781-862-7893

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	08/28/2009

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