Individual
DR. MATT DANIEL SLATALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 FRUIT STREET, CLN 309 ANESTHESIA ASSOCIATES, BOSTON, MA 02114-2696
(617) 665-1630
(617) 665-1091
Mailing address
PO BOX 9142, MASS GENERAL PHYSICIAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-0287
(617) 726-2894
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
209222
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0196037
—
MA
01
—
209222
TUFTS HEALTH PLAN
MA
01
—
J24069
BCBS MA
MA
Enumeration date
02/09/2006
Last updated
09/01/2015
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