MEDICARE: THOMAS RAYMOND SLATTERY JR. 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	208D00000X	General Practice Physician	0101235689	VA
2	2085R0202X	Diagnostic Radiology Physician	MD442369	PA

General Provider Information

NPI Number	:	1235115601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS RAYMOND SLATTERY JR. MD

Provider Business Mailing Address
First Line	:	250 KING OF PRUSSIA RD
Second Line	:	3RD FL.
City	:	RADNOR
State	:	PA
Zip	:	19087-5235
Country	:	US
Telephone Number	:	610-902-5775
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 KING OF PRUSSIA RD
Second Line	:	3RD FL.
City	:	RADNOR
State	:	PA
Zip	:	19087-5235
Country	:	US
Telephone Number	:	610-902-5775
Fax Number	:

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	07/24/2014

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