Basic Information
| Provider Information | |||||||||
| NPI: | 1124060736 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SLAVSKY | ||||||||
| FirstName: | TATIANA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 40 HOLLAND ST | ||||||||
| Address2: | |||||||||
| City: | SOMERVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021442705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176296350 | ||||||||
| FaxNumber: | 6176296067 | ||||||||
| Practice Location | |||||||||
| Address1: | 40 HOLLAND ST | ||||||||
| Address2: | INTERNAL MEDICINE | ||||||||
| City: | SOMERVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021442705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6176296350 | ||||||||
| FaxNumber: | 6176296067 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 03/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 80074 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 080074 | 01 | MA | TUFTS | OTHER | J31035 | 01 | MA | BLUE CROSS | OTHER | HV0084 | 01 | MA | HARVARD PILGRIM | OTHER | 3144437 | 05 | MA | MEDICAID | 0002484 | 01 | MA | NEIGHBORHOOD HEALTH | OTHER |