Provider Demographics
NPI:1518955004
Name:SLAVITT, JEROME ALAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:JEROME
Middle Name:ALAN
Last Name:SLAVITT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7402 YORK ROAD
Mailing Address - Street 2:STE 104-105
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-825-2443
Mailing Address - Fax:410-321-7040
Practice Address - Street 1:10 WARREN RD
Practice Address - Street 2:SUITE 130
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030
Practice Address - Country:US
Practice Address - Phone:410-628-1066
Practice Address - Fax:410-683-1354
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD485213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P871OtherHCVA
T59519Medicare UPIN
P871OtherHCVA