Provider Demographics
NPI:1811576812
Name:SLATER, JERRY LEROY
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:LEROY
Last Name:SLATER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 RIDGE RD APT 5
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-1641
Mailing Address - Country:US
Mailing Address - Phone:202-222-8236
Mailing Address - Fax:
Practice Address - Street 1:3700 9TH ST SE APT 419
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4021
Practice Address - Country:US
Practice Address - Phone:202-702-6322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant