Provider Demographics
NPI:1780682625
Name:SLATER, STANLEY LAURENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:LAURENCE
Last Name:SLATER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9127 MARSEILLE DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2202
Mailing Address - Country:US
Mailing Address - Phone:301-983-1931
Mailing Address - Fax:
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:STE 802
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4462
Practice Address - Country:US
Practice Address - Phone:240-447-9051
Practice Address - Fax:301-652-9051
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00174572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
15-01527OtherUNITED HEALTH CARE
MDM232C2OtherCONTROLLED DRUGS
MDM232C2OtherCONTROLLED DRUGS
F05815Medicare UPIN