Provider Demographics
NPI:1578557393
Name:SLATER, DOUGLAS KENNETH (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:KENNETH
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:PO BOX 7200
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0200
Mailing Address - Country:US
Mailing Address - Phone:252-937-0200
Mailing Address - Fax:252-451-0056
Practice Address - Street 1:901 N WINSTEAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8467
Practice Address - Country:US
Practice Address - Phone:252-937-0235
Practice Address - Fax:252-937-3103
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC33425207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC897679VMedicaid
NC110124024OtherRAILROARD MEDICARE
NC6930356OtherCIGNA HEALTHCARE
ND69724OtherMEDCOST
NC7679VOtherBCBSNC
NC110124024OtherRAILROARD MEDICARE
NCE3.7024Medicare UPIN