1548470131 NPI number — ADRIANA SPANOVA MD

Table of content: ADRIANA SPANOVA MD (NPI 1548470131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548470131 NPI number — ADRIANA SPANOVA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPANOVA
Provider First Name:
ADRIANA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1548470131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 890631
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28289-0631
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-949-5482
Provider Business Mailing Address Fax Number:
812-948-6715

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3605 NORTHGATE CT
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
NEW ALBANY
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47150-6400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-941-9355
Provider Business Practice Location Address Fax Number:
812-941-9312
Provider Enumeration Date:
05/23/2007

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: 207Q00000X , with the licence number:  L2758 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: 01066620A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200945630 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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