Basic Information
| Provider Information | |||||||||
| NPI: | 1720045925 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SLOCUM | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30 LOCUST ST | ||||||||
| Address2: | |||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010602052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135822363 | ||||||||
| FaxNumber: | 4135822914 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 LOCUST ST | ||||||||
| Address2: | |||||||||
| City: | NORTHAMPTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 010602052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4135822363 | ||||||||
| FaxNumber: | 4135822914 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 42118 | MA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 042118 | 01 | MA | TUFTS | OTHER | 102520 | 01 | MA | CIGNA | OTHER | 438838 | 01 | MA | HARVARD PILGRIM | OTHER | 2381540 | 01 | MA | AETNA | OTHER | 3029239 | 05 | MA | MEDICAID | 632919 | 01 | MA | CONNECTICARE | OTHER | 000000006700 | 01 | MA | BMC | OTHER | J06893 | 01 | MA | BCBS MA | OTHER | 24923 | 01 | MA | HEALTH NEW ENGLAND | OTHER |