Provider Demographics
NPI:1124060736
Name:SLAVSKY, TATIANA (MD)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:
Last Name:SLAVSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HOLLAND ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2705
Mailing Address - Country:US
Mailing Address - Phone:617-629-6350
Mailing Address - Fax:617-629-6067
Practice Address - Street 1:40 HOLLAND ST
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2705
Practice Address - Country:US
Practice Address - Phone:617-629-6350
Practice Address - Fax:617-629-6067
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA80074207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA080074OtherTUFTS
MAJ31035OtherBLUE CROSS
MAHV0084OtherHARVARD PILGRIM
MA3144437Medicaid
MA0002484OtherNEIGHBORHOOD HEALTH
MAJ31035OtherBLUE CROSS
MA3144437Medicaid