Organization
SLOCUM DICKSON MEDICAL GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEPHEN D. EADLINE MD (PRESIDENT)
(315) 798-1700
Entity
Organization
Contact information
Practice address
1729 BURRSTONE RD, NEW HARTFORD, NY 13413-1001
(315) 798-1700
(315) 798-1707
Mailing address
1729 BURRSTONE RD, NEW HARTFORD, NY 13413-1001
(315) 798-1700
(315) 798-1707
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
47440
NY
291U00000X
Clinical Medical Laboratory
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02995013
—
NY
Enumeration date
11/02/2005
Last updated
06/11/2021
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