Provider Demographics
NPI:1457463002
Name:SLOGOFF, FREDERICK B (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:B
Last Name:SLOGOFF
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 1:5 HIGH RIDGE PARK
Mailing Address - Street 2:SUITE 104
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06905-1332
Mailing Address - Country:US
Mailing Address - Phone:203-968-9500
Mailing Address - Fax:203-968-9501
Practice Address - Street 1:5 HIGH RIDGE PARK
Practice Address - Street 2:SUITE 104
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06905-1332
Practice Address - Country:US
Practice Address - Phone:203-968-9500
Practice Address - Fax:203-968-9501
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038474207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001384742Medicaid
CTH11362Medicare UPIN
CT11007863Medicare ID - Type Unspecified