Basic Information
Provider Information | |||||||||
NPI: | 1548219488 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SLOMPAK-PATTON | ||||||||
FirstName: | CAROL | ||||||||
MiddleName: | A | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1605 N CEDAR CREST BLVD | ||||||||
Address2: | SUITE 110B | ||||||||
City: | ALLENTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 181042351 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6109731410 | ||||||||
FaxNumber: | 6109731449 | ||||||||
Practice Location | |||||||||
Address1: | 401 N 17TH ST | ||||||||
Address2: | SUITE 201 | ||||||||
City: | ALLENTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 181045034 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6104326862 | ||||||||
FaxNumber: | 4844034022 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/09/2006 | ||||||||
LastUpdateDate: | 09/28/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/28/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD029922E | PA | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207RG0300X | MD029922E | PA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
ID Information
ID | Type | State | Issuer | Description | 380001488 | 01 | PA | PALMETTO GBA MEDICARE | OTHER | 01037401 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 198705 | 01 | PA | HIGHMARK PA BLUE SHIELD | OTHER |