Provider Demographics
NPI:1417027830
Name:SLATER, CATHY A (MD)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:A
Last Name:SLATER
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 1:4049 CAPITAL DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-3123
Mailing Address - Country:US
Mailing Address - Phone:252-446-7546
Mailing Address - Fax:252-446-9109
Practice Address - Street 1:4049 CAPITAL DR
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3123
Practice Address - Country:US
Practice Address - Phone:252-446-7546
Practice Address - Fax:252-446-9109
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94-01044207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC05-0618334OtherTAXID(EIN)
NCF83814Medicare UPIN
NC2200743BMedicare ID - Type Unspecified