Provider Demographics
NPI:1194709493
Name:COLTON-SLOTTER, ANGELINA MARIE (DPM)
Entity type:Individual
Prefix:DR
First Name:ANGELINA
Middle Name:MARIE
Last Name:COLTON-SLOTTER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:ANGELINA
Other - Middle Name:MARIE
Other - Last Name:COLTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:3120 N OLD TRL STE A
Mailing Address - Street 2:
Mailing Address - City:SHAMOKIN DAM
Mailing Address - State:PA
Mailing Address - Zip Code:17876-9428
Mailing Address - Country:US
Mailing Address - Phone:570-374-3668
Mailing Address - Fax:570-374-7306
Practice Address - Street 1:3120 N OLD TRL STE A
Practice Address - Street 2:
Practice Address - City:SHAMOKIN DAM
Practice Address - State:PA
Practice Address - Zip Code:17876-9428
Practice Address - Country:US
Practice Address - Phone:570-374-3668
Practice Address - Fax:570-374-7306
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004206R213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA879990WK6OtherMEDICARE ID
PA0015896440005Medicaid
U62053Medicare UPIN