Provider Demographics
NPI:1427067974
Name:SLATTERY, MAUREEN REBECCA (MD)
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:REBECCA
Last Name:SLATTERY
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 1:995 SENATOR KEATING BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2776
Mailing Address - Country:US
Mailing Address - Phone:585-368-4455
Mailing Address - Fax:585-271-3688
Practice Address - Street 1:995 SENATOR KEATING BLVD STE 210
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2776
Practice Address - Country:US
Practice Address - Phone:585-368-4455
Practice Address - Fax:585-271-3688
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243335207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02906623Medicaid
NYJ400031759/GP 70008AMedicare PIN
NYJ400031757/GP BA0017Medicare PIN