MEDICARE: DR. JONATHAN 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	207RN0300X	Nephrology Physician	81014	MA
2	207RN0300X	Nephrology Physician	032013	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	64747	OTHER	MA	FALLON
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	10252	OTHER	MA	HARVARD PILGRIM

General Provider Information

NPI Number	:	1992788160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN SLATER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 70266
Second Line	:
City	:	SPRINGFIELD
State	:	MA
Zip	:	01107-0266
Country	:	US
Telephone Number	:	413-733-9666
Fax Number	:	413-750-3432

Provider Business Practice Location Address
First Line	:	100 WASON AVE
Second Line	:	SUITE 200
City	:	SPRINGFIELD
State	:	MA
Zip	:	01107-1381
Country	:	US
Telephone Number	:	413-733-9666
Fax Number	:	413-750-3432

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

Provider Enumeration Date	:	11/22/2005
Last Update Date	:	02/06/2015

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