Provider Demographics
NPI:1558350033
Name:SLOCUM, HAROLD E (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:E
Last Name:SLOCUM
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:PO BOX 636643
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6643
Mailing Address - Country:US
Mailing Address - Phone:440-989-3801
Mailing Address - Fax:440-960-0264
Practice Address - Street 1:319 W LORAIN ST
Practice Address - Street 2:
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1027
Practice Address - Country:US
Practice Address - Phone:440-988-1009
Practice Address - Fax:440-988-1227
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35060586207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0807274Medicaid
OH3025372Medicaid
OH0236248Medicaid
B37305Medicare UPIN
OH9389631Medicare PIN
OH9284951Medicare PIN
OH0678635Medicare ID - Type Unspecified
OH0807274Medicaid
OH010059853Medicare PIN
OHH120472Medicare PIN