Provider Demographics
NPI:1518947282
Name:SLATER, DANIEL H (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:H
Last Name:SLATER
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 1:485 ARSENAL ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-5091
Mailing Address - Country:US
Mailing Address - Phone:617-972-5570
Mailing Address - Fax:617-972-5593
Practice Address - Street 1:485 ARSENAL ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-5091
Practice Address - Country:US
Practice Address - Phone:617-972-5570
Practice Address - Fax:671-972-5593
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79924208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA079924OtherTUFTS
MAJ30897OtherBLUE CROSS
MA0015167OtherNEIGHBORHOOD HEALTH
MAPP607OtherHARVARD PILGRIM
MA3190684Medicaid
MA079924OtherTUFTS
MAJ30897OtherBLUE CROSS