Provider Demographics
NPI:1285151993
Name:SLAVIN, KYLE
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:
Last Name:SLAVIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 WICKHAM WAY
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-2904
Mailing Address - Country:US
Mailing Address - Phone:410-507-1067
Mailing Address - Fax:
Practice Address - Street 1:975 BAY RIDGE RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-3934
Practice Address - Country:US
Practice Address - Phone:410-268-7688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25207183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist