Provider Demographics
NPI:1215292370
Name:SLONE, ALEENA NICOLE (MD)
Entity type:Individual
Prefix:
First Name:ALEENA
Middle Name:NICOLE
Last Name:SLONE
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 1:3170 KETTERING BLVD BLDG B3
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1924
Mailing Address - Country:US
Mailing Address - Phone:937-991-3188
Mailing Address - Fax:937-223-9811
Practice Address - Street 1:4940 COTTONVILLE RD STE 100
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:OH
Practice Address - Zip Code:45335-1522
Practice Address - Country:US
Practice Address - Phone:937-675-6830
Practice Address - Fax:937-675-6835
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYR2641207Q00000X
OH35124126207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0106687Medicaid
OHH353950Medicare PIN
OHH353951Medicare PIN