Provider Demographics
NPI:1043213630
Name:SLAUNWHITE, REBECCA M (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:SLAUNWHITE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6495 E BROAD ST STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-1541
Mailing Address - Country:US
Mailing Address - Phone:614-866-8077
Mailing Address - Fax:614-866-9752
Practice Address - Street 1:6495 E BROAD ST STE A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-1541
Practice Address - Country:US
Practice Address - Phone:614-866-8077
Practice Address - Fax:614-866-9752
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.095670208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3086815Medicaid
PA1010737930002Medicaid