Provider Demographics
NPI:1669565933
Name:SLAUGHTER, ROSALYN LR (MD)
Entity type:Individual
Prefix:DR
First Name:ROSALYN
Middle Name:LR
Last Name:SLAUGHTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7750 GREENWELL SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70814-2003
Mailing Address - Country:US
Mailing Address - Phone:225-928-9550
Mailing Address - Fax:225-925-3279
Practice Address - Street 1:7750 GREENWELL SPRINGS RD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70814-2003
Practice Address - Country:US
Practice Address - Phone:225-928-9550
Practice Address - Fax:225-925-3279
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019151208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1447650Medicaid
LAG01748Medicare UPIN