Provider Demographics
NPI:1871597625
Name:SLOWIKOWSKI, JACEK S (MD)
Entity type:Individual
Prefix:
First Name:JACEK
Middle Name:S
Last Name:SLOWIKOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 CRYSTAL SPRING AVE SW
Mailing Address - Street 2:STE 300
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-2465
Mailing Address - Country:US
Mailing Address - Phone:540-342-7941
Mailing Address - Fax:540-345-8423
Practice Address - Street 1:2001 CRYSTAL SPRING AVE SW
Practice Address - Street 2:STE 300
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-2465
Practice Address - Country:US
Practice Address - Phone:540-342-7941
Practice Address - Fax:540-345-8423
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047687207RC0000X
VA010147687174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5804876Medicaid
VA006073115Medicaid
VA06000440Medicare ID - Type Unspecified
VA060064687Medicare PIN
VA006073115Medicaid
VA060001090Medicare PIN