1912004813 NPI number — JAMES SPELLMAN MD LLC

Table of content: (NPI 1912004813)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912004813 NPI number — JAMES SPELLMAN MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAMES SPELLMAN MD LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912004813
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 279
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NASSAU
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-644-0964
Provider Business Mailing Address Fax Number:
302-644-0968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
431 SAVANNAH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWES
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-644-0964
Provider Business Practice Location Address Fax Number:
302-644-0968
Provider Enumeration Date:
09/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MERLO
Authorized Official First Name:
JOANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
302-644-0964

Provider Taxonomy Codes

  • Taxonomy code: 2086X0206X , with the licence number:  C10004807 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)