Provider Demographics
NPI:1720045925
Name:SLOCUM, ROBERT S (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
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 1:65 UNION ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:VT
Mailing Address - Zip Code:05089-1504
Mailing Address - Country:US
Mailing Address - Phone:413-302-2538
Mailing Address - Fax:
Practice Address - Street 1:65 UNION ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:VT
Practice Address - Zip Code:05089-1504
Practice Address - Country:US
Practice Address - Phone:413-302-2538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT4003207P00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA04-3329195OtherNORTHEAST HEALTH DIRECT
MA04-3329195OtherNORTH AMERICAN PREFERRED
MA04-3329195OtherPHCS
MA000000006700OtherBMC
MA042118OtherTUFTS
MA2381540OtherAETNA
MA04-3329195OtherPLAN VISTA
MA632919OtherCONNECTICARE
MAJ06893OtherBCBS MA
MA04-3329195OtherCONSOLIDATED
MA04-3329195OtherNORTHEAST HEALTHCARE ALLI
MA3029239Medicaid
MA102520OtherCIGNA
MA24923OtherHEALTH NEW ENGLAND
MA04-3329195OtherUNICARE/GIC
MA438838OtherHARVARD PILGRIM