Provider Demographics
NPI:1831325661
Name:SLACK, MARIA ADELAIDA (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ADELAIDA
Last Name:SLACK
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 1:1900 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840-1214
Mailing Address - Country:US
Mailing Address - Phone:419-423-4500
Mailing Address - Fax:419-423-5550
Practice Address - Street 1:1816 CHAPEL DR STE G
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-1343
Practice Address - Country:US
Practice Address - Phone:419-423-5470
Practice Address - Fax:419-423-7670
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-08
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.099962207K00000X
NY281330207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology