Provider Demographics
NPI:1407834450
Name:SLONIM, CHARLES B (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:B
Last Name:SLONIM
Suffix:
Gender:M
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 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-7770
Mailing Address - Country:US
Mailing Address - Phone:813-974-3820
Mailing Address - Fax:
Practice Address - Street 1:13127 USF MAGNOLIA DR
Practice Address - Street 2:MDC 21
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:813-974-3820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39639207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL180018138OtherRAILROAD MEDICARE
FL30465OtherBCBS INDIVIDUAL #
FL656397OtherAETNA
FLME0039639OtherSTATE LICENSE #
FL1772596009OtherCIGNA
FL274163600Medicaid
FLP00973220Medicare PIN
FL30465OtherBCBS INDIVIDUAL #
FLD54002Medicare UPIN