Provider Demographics
NPI:1033109236
Name:SLATTERY, JOHN GORMLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GORMLEY
Last Name:SLATTERY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:925 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAST GREENWICH
Mailing Address - State:RI
Mailing Address - Zip Code:02818-3116
Mailing Address - Country:US
Mailing Address - Phone:401-884-5333
Mailing Address - Fax:401-884-5664
Practice Address - Street 1:925 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST GREENWICH
Practice Address - State:RI
Practice Address - Zip Code:02818-3116
Practice Address - Country:US
Practice Address - Phone:401-884-5333
Practice Address - Fax:401-884-5664
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
RIRI8483207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI089020169Medicare PIN
RIF-62671Medicare UPIN