Provider Demographics
NPI:1235195116
Name:SLIZOVSKY, MIRA N (MD)
Entity Type:Individual
Prefix:MRS
First Name:MIRA
Middle Name:N
Last Name:SLIZOVSKY
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 1:217 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:PALMERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18071-1509
Mailing Address - Country:US
Mailing Address - Phone:610-826-1166
Mailing Address - Fax:610-824-5121
Practice Address - Street 1:217 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-1509
Practice Address - Country:US
Practice Address - Phone:610-826-1166
Practice Address - Fax:610-824-5121
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065630L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017085760001Medicaid
PA0017085760001Medicaid