Individual
JASON SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
11116 MEDICAL CAMPUS RD, HAGERSTOWN, MD 21742-6710
(301) 790-8804
Mailing address
11116 MEDICAL CAMPUS RD, HAGERSTOWN, MD 21742-6710
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
05-40745
KS
207R00000X
Internal Medicine Physician
2015017143
MO
207R00000X
Internal Medicine Physician
Primary
H96459
MD
Other
Enumeration date
06/25/2015
Last updated
12/29/2023
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