Provider Demographics
NPI:1023167020
Name:SLAUGHTER, MICHAEL CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHARLES
Last Name:SLAUGHTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:536 BAY RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-1425
Mailing Address - Country:US
Mailing Address - Phone:518-793-2483
Mailing Address - Fax:518-793-2485
Practice Address - Street 1:536 BAY RD
Practice Address - Street 2:SUITE 1
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1425
Practice Address - Country:US
Practice Address - Phone:518-793-2483
Practice Address - Fax:518-793-2485
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY151698207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10001916OtherCDPHP
NY11W8136741OtherWORKER'S COMP
NY03010OtherMVP
NY00747599Medicaid
NY00747599Medicaid
NY11W8136741OtherWORKER'S COMP