Provider Demographics
NPI:1083618326
Name:SLONE, SALLI SMITH (MD)
Entity Type:Individual
Prefix:
First Name:SALLI
Middle Name:SMITH
Last Name:SLONE
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:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40423-0006
Mailing Address - Country:US
Mailing Address - Phone:859-236-0916
Mailing Address - Fax:859-236-0917
Practice Address - Street 1:111 DANIEL DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2527
Practice Address - Country:US
Practice Address - Phone:859-236-0916
Practice Address - Fax:859-236-0917
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32347174400000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64323470Medicaid
KY0643501Medicare ID - Type UnspecifiedMEDICARE #
KY64323470Medicaid