Provider Demographics
NPI:1104037464
Name:SLAVICK, LORI JO (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:JO
Last Name:SLAVICK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:JO
Other - Last Name:MARKOWITZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10956 SASSAN LN
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-4069
Mailing Address - Country:US
Mailing Address - Phone:248-939-7845
Mailing Address - Fax:
Practice Address - Street 1:131 E MCKINLEY ST
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-3522
Practice Address - Country:US
Practice Address - Phone:248-939-7845
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004018363A00000X
MDC04986363A00000X
PAOA004693363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant