Provider Demographics
NPI:1386693687
Name:SLAVOSKI, LINDA A (MD)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:SLAVOSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:545 N RIVER ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-2600
Mailing Address - Country:US
Mailing Address - Phone:570-822-6036
Mailing Address - Fax:570-829-1520
Practice Address - Street 1:545 N RIVER ST
Practice Address - Street 2:SUITE 205
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-2600
Practice Address - Country:US
Practice Address - Phone:570-822-6036
Practice Address - Fax:570-829-1520
Is Sole Proprietor?:No
Enumeration Date:2006-05-06
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD048865L207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014227930006Medicaid
PA801211OtherFIRST PRIORITY HEALTH
PA101302OtherUNISON HEALTH PLAN
PA16665OtherGEISINGER HEALTH PLAN
PA080366OtherHIGHMARK BLUE SHIELD
PA080366OtherFIRST PRIORITY LIFE
PA080366OtherHIGHMARK BLUE SHIELD
PA16665OtherGEISINGER HEALTH PLAN