Provider Demographics
NPI:1689790800
Name:SLADE MEDICAL CENTER
Entity Type:Organization
Organization Name:SLADE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-602-0407
Mailing Address - Street 1:304 REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-5312
Mailing Address - Country:US
Mailing Address - Phone:419-602-0407
Mailing Address - Fax:410-602-0409
Practice Address - Street 1:304 REISTERSTOWN RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-5312
Practice Address - Country:US
Practice Address - Phone:419-602-0407
Practice Address - Fax:410-602-0409
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251H1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHuman FactorsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD070LMedicare ID - Type UnspecifiedPHYSICAL THERAPY