Basic Information
| Provider Information | |||||||||
| NPI: | 1285661561 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SLABAUGH | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4102 PINION DR | ||||||||
| Address2: | |||||||||
| City: | USAF ACADEMY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 808402502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193335040 | ||||||||
| FaxNumber: | 7193335868 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 SAINT PAUL ST | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212022102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105392227 | ||||||||
| FaxNumber: | 4105392240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 04/02/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0005X | 036-120693 | IL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1633878 | 01 | IL | BCBS | OTHER |