Provider Demographics
NPI:1215027362
Name:SLUTSKER, VLADIMIR (DO)
Entity Type:Individual
Prefix:
First Name:VLADIMIR
Middle Name:
Last Name:SLUTSKER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8439 SCOTT DR
Mailing Address - Street 2:
Mailing Address - City:TRUSSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35173-3805
Mailing Address - Country:US
Mailing Address - Phone:540-786-6669
Mailing Address - Fax:
Practice Address - Street 1:801 GOODYEAR AVE
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1133
Practice Address - Country:US
Practice Address - Phone:256-439-5011
Practice Address - Fax:256-439-5002
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO-899208100000X
VA0102203302208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009933742Medicaid
VA0484567OtherCIGNA
VA1215027362Medicaid
AL009933742Medicaid
AL051556319SLUMedicare ID - Type Unspecified
VA1215027362Medicare PIN