Basic Information
| Provider Information | |||||||||
| NPI: | 1962424879 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SLEZAK | ||||||||
| FirstName: | SHERI | ||||||||
| MiddleName: | S. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 64226 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212644742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103286897 | ||||||||
| FaxNumber: | 4103282109 | ||||||||
| Practice Location | |||||||||
| Address1: | 22 S GREENE ST | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212011544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103286897 | ||||||||
| FaxNumber: | 4103282109 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 03/08/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | D32924 | MA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0035 | 01 | MD | CAREFIRST REGIONAL | OTHER | 79986 | 01 | MD | GEISINGER | OTHER | 213358 | 01 | MD | KAISER | OTHER | 1700528 | 01 | MD | UNITED HLTHCARE | OTHER | 216993 | 01 | MD | MDIPA | OTHER | 964068 | 01 | MD | UNITED HLTHCARE NATIONAL | OTHER | 16068 | 01 | MD | FREESTATE | OTHER | 207471100 | 05 | MD | MEDICAID |