1205045952 NPI number — AMY ELIZABETH SPANGLER PA

Table of content: AMY ELIZABETH SPANGLER PA (NPI 1205045952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205045952 NPI number — AMY ELIZABETH SPANGLER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPANGLER
Provider First Name:
AMY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

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:
1205045952
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
301 WATERSVILLE RD
Provider Second Line Business Mailing Address:
STE 2
Provider Business Mailing Address City Name:
MOUNT AIRY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21771-5513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-345-7375
Provider Business Mailing Address Fax Number:
301-345-7269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7701 GREENBELT RD
Provider Second Line Business Practice Location Address:
SUITE 504
Provider Business Practice Location Address City Name:
GREENBELT
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20770-2037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-345-7375
Provider Business Practice Location Address Fax Number:
301-345-7269
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  C0002744 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PA57438 . This is a "CDS NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: C0002744 . This is a "MD LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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