Basic Information
| Provider Information | |||||||||
| NPI: | 1821080748 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SLATER | ||||||||
| FirstName: | TODD | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 637736 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452637736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5138911006 | ||||||||
| FaxNumber: | 5137931032 | ||||||||
| Practice Location | |||||||||
| Address1: | 1487 N HIGH ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | HILLSBORO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451338496 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373933406 | ||||||||
| FaxNumber: | 9373930511 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2005 | ||||||||
| LastUpdateDate: | 10/02/2012 | ||||||||
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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 | 207V00000X | 35-050621 | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0653561 | 01 | OH | AETNA | OTHER | 160054320 | 01 | OH | RAILROAD MEDICARE | OTHER | 000000198158 | 01 | OH | ANTHEM | OTHER | 0720464 | 01 | OH | UHC | OTHER | 311674981 | 01 | OH | OTHER FACILITY TAX ID NUM | OTHER | 0590365 | 05 | OH | MEDICAID | 2355062 | 01 | OH | RHC MEDICAID CLINIC NUM. | OTHER | 363843 | 01 | OH | RHC MEDICARE CLINIC NUM. | OTHER |