Provider Demographics
NPI:1457456980
Name:SLATER, JOSEPH M (PA)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:M
Last Name:SLATER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1353 BOSTON POST RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-3445
Mailing Address - Country:US
Mailing Address - Phone:203-245-4933
Mailing Address - Fax:203-245-4399
Practice Address - Street 1:1353 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3445
Practice Address - Country:US
Practice Address - Phone:203-245-4933
Practice Address - Fax:203-245-4399
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000090363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT706112OtherCONNECTICARE
CT290000090CT01OtherANTHEM BC/BS
CT706112OtherCONNECTICARE