Provider Demographics
NPI:1801852637
Name:SLOANE, MARK FREDERICK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:FREDERICK
Last Name:SLOANE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:436 3RD AVE
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6025
Mailing Address - Country:US
Mailing Address - Phone:212-685-6660
Mailing Address - Fax:212-481-7224
Practice Address - Street 1:436 3RD AVE
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6025
Practice Address - Country:US
Practice Address - Phone:212-685-6660
Practice Address - Fax:212-481-7224
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY169212207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBS1918335OtherDEA#
NYBS1918335OtherDEA#
NY0403383Medicare ID - Type UnspecifiedM'CARE COMPLETE PROVIDER#
NY1332155Medicare PIN