Provider Demographics
NPI:1194773911
Name:SLAUGHTER, DOUGLAS A (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:A
Last Name:SLAUGHTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 US HIGHWAY 22 STE 14
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2943
Mailing Address - Country:US
Mailing Address - Phone:973-376-6595
Mailing Address - Fax:732-399-6475
Practice Address - Street 1:1200 US HIGHWAY 22 STE 14
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-2943
Practice Address - Country:US
Practice Address - Phone:973-376-6595
Practice Address - Fax:732-399-6475
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV22512207XS0117X
FLME134221207XS0117X
NY217718207XS0117X
PAMD469501207XS0117X
NJ25MA09980900207XS0117X
AZ23614207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM74132067Medicaid
QMP000003391181OtherMOLINA
NMNM002Q02OtherBCBS NM
10034053OtherLOVELACE
2029647OtherUHC
AZD125395Medicare UPIN
QMP000003391181OtherMOLINA
2029647OtherUHC
NM346719312Medicare PIN
AZ66049Medicare ID - Type Unspecified
346719312Medicare PIN