Individual
DR. KENNETH C SLATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
113 SHORT ST, POUNDING MILL, VA 24637-4278
(540) 212-6090
Mailing address
PO BOX 3997, WISE, VA 24293-3997
Taxonomy
Speciality
Code
Description
License number
State
204D00000X
Neuromusculoskeletal Medicine & OMM Physician
0101051566
VA
207R00000X
Internal Medicine Physician
Primary
0101051566
VA
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
0101051566
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
VA
Enumeration date
05/23/2006
Last updated
09/21/2022
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