Provider Demographics
NPI:1669528410
Name:SLAWSKY, RICHARD CHARLES (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:CHARLES
Last Name:SLAWSKY
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 1:71 LOS CERROS PL
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3106
Mailing Address - Country:US
Mailing Address - Phone:510-304-1809
Mailing Address - Fax:
Practice Address - Street 1:71 LOS CERROS PL
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3106
Practice Address - Country:US
Practice Address - Phone:510-304-1809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2013-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG568022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G568020Medicare ID - Type Unspecified
CAE72090Medicare UPIN