MEDICARE: DAVID M. SLACK MD

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	207R00000X	Internal Medicine Physician	72497	MA
2	208000000X	Pediatrics Physician	72497	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	16474	OTHER	MA	HEALTH NEW ENGLAND
2	2358373	OTHER	MA	AETNA
3	740008	OTHER	MA	CONNECTICARE
4	J09911	OTHER	MA	BCBSMA
5	000000007738	OTHER	MA	BOSTON MEDICAL CENTER HEALTHNET PLAN
6	1293916	OTHER	MA	FALLON
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	1024130	OTHER	MA	CIGNA
9	63401	OTHER	MA	HARVARD PILGRIM
10	729533	OTHER	MA	TUFTS

General Provider Information

NPI Number	:	1205895554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID M. SLACK MD

Provider Business Mailing Address
First Line	:	PO BOX 8019
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01102-8000
Country	:	US
Telephone Number	:	866-431-4077
Fax Number	:	413-774-7448

Provider Business Practice Location Address
First Line	:	179 NORTHAMPTON ST
Second Line	:	#H
City	:	EASTHAMPTON
State	:	MA
Zip	:	01027-1057
Country	:	US
Telephone Number	:	413-529-9300
Fax Number	:	413-527-9793

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	06/17/2008

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Directions to “ DAVID M. SLACK MD” Practice Location

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