Individual
MR. DARRYL SPENCER SLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
11110 MEDICAL CAMPUS ROAD, SUITE 147, MERITUS HEALTH SYSTEM, HAGERSTOWN, MD 21742
(240) 313-9600
(240) 313-9601
Mailing address
12911 CLOPPER RD, HAGERSTOWN, MD 21742-4811
(240) 527-4378
(240) 313-9601
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
C0000715
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C0000715
STATE LICENSE #
MD
Enumeration date
08/16/2006
Last updated
09/18/2013
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