Basic Information
| Provider Information | |||||||||
| NPI: | 1386844702 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SLATE | ||||||||
| FirstName: | GARRICK | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 WHITING HILL RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | BREWER | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044121005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079734670 | ||||||||
| FaxNumber: | 2079734669 | ||||||||
| Practice Location | |||||||||
| Address1: | 417 STATE ST | ||||||||
| Address2: | SUITE 141 | ||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044016630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079734670 | ||||||||
| FaxNumber: | 2079734669 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2007 | ||||||||
| LastUpdateDate: | 07/28/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 25MA10909400 | NJ | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VX0000X | 0101243956 | VA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Obstetrics | 207V00000X | 53114 | KY | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 018106 | ME | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.