1609864982 NPI number — DR. JAMES E. SPELLMAN JR. MD

Table of content: ETHELENE POPE (NPI 1538333984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609864982 NPI number — DR. JAMES E. SPELLMAN JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPELLMAN
Provider First Name:
JAMES
Provider Middle Name:
E.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1609864982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 SAVANNAH RD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
LEWES
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19958-1499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-645-6555
Provider Business Mailing Address Fax Number:
302-644-3560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18947 JOHN J WILLIAMS HWY
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
REHOBOTH BEACH
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19971-4474
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:
10/11/2005

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: 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)

  • Identifier: 000000207585 . This is a "UNISON HEALTH CARE-MCAID" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1609864982 . This is a "DIAMOND STATE MEDICAID" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1609864982 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1609864982 . This is a "DE PHYSICIAN CARE-MCAID" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 522011SUR . This is a "BCBS OF DELAWARE-SURGICAL" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 563293 . This is a "COVENTRY HEALTH CARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: P00397509 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com