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Individual

MICHAEL C SLACK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
22 S GREENE ST, N5W70C, BALTIMORE, MD 21201-1544
(410) 328-2427
(443) 462-3137
Mailing address
PO BOX 62063, BALTIMORE, MD 21264-2063
(410) 706-5181
(410) 706-5103

Taxonomy

Speciality
Code
Description
License number
State
2080P0202X
Pediatric Cardiology Physician
Primary
D55380
MD
2080P0202X
Pediatric Cardiology Physician
MD31860
DC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
028095100
DC
01
0614
CAREFIRST
DC
05
202009200
MD
05
202009201
MD
05
6731538
VA
Enumeration date
10/02/2006
Last updated
01/05/2015
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