Basic Information
| Provider Information | |||||||||
| NPI: | 1346291416 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SLONE | ||||||||
| FirstName: | HASEL | ||||||||
| MiddleName: | WAYNE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 395 W 12TH AVE RM 460 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432101267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142938315 | ||||||||
| FaxNumber: | 6142936935 | ||||||||
| Practice Location | |||||||||
| Address1: | 395 W 12TH AVE RM 460 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432101267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142938315 | ||||||||
| FaxNumber: | 6142936935 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 35060675 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0858568 | 05 | OH | MEDICAID |