Basic Information
| Provider Information | |||||||||
| NPI: | 1447235486 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SLATER | ||||||||
| FirstName: | DENNIS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 WASHINGTON ST | ||||||||
| Address2: | EASTERN CT HEMATOLOGY & ONCOLOGY SUITE 220 | ||||||||
| City: | NORWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063602700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608868362 | ||||||||
| FaxNumber: | 8608869262 | ||||||||
| Practice Location | |||||||||
| Address1: | 330 WASHINGTON ST | ||||||||
| Address2: | EASTERN CT HEMATOLOGY & ONCOLOGY SUITE 220 | ||||||||
| City: | NORWICH | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063602700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8608868362 | ||||||||
| FaxNumber: | 8608869262 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2005 | ||||||||
| LastUpdateDate: | 07/22/2013 | ||||||||
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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 | 207RH0000X | 026872 | CT | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology | 207R00000X | 026872 | CT | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001268721 | 05 | CT | MEDICAID | 0113957 | 01 | CT | AETNA | OTHER | 010026872CT02 | 01 | CT | BCBS | OTHER |