Provider Demographics
NPI:1306938337
Name:SLANKARD, MARJORIE L (MD)
Entity type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:L
Last Name:SLANKARD
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 1:3020 CHILDRENS WAY # MC5003
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4223
Mailing Address - Country:US
Mailing Address - Phone:858-309-6300
Mailing Address - Fax:
Practice Address - Street 1:8110 BIRMINGHAM WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2758
Practice Address - Country:US
Practice Address - Phone:858-966-5961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118422207RA0201X
NJ25MA05760500207RA0201X
CAG33880207K00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY108636OtherUNITED HEALTHCARE
NJNL9296OtherGUARDIAN
NY1796867-002OtherCIGNA
NYNS1113OtherOXFORD
NJNS1113OtherOXFORD
NYNY2078OtherGUARDIAN
NYNS1113OtherOXFORD
NJB00077Medicare UPIN
NJB00077Medicare UPIN
NYB00077Medicare UPIN