Provider Demographics
NPI:1023032208
Name:SPAGNOLA, ALAN MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:MICHAEL
Last Name:SPAGNOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WILDWOOD MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426-1154
Mailing Address - Country:US
Mailing Address - Phone:860-767-0145
Mailing Address - Fax:860-767-0021
Practice Address - Street 1:10 WILDWOOD MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426-1154
Practice Address - Country:US
Practice Address - Phone:860-767-0145
Practice Address - Fax:860-767-0021
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT019375207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001193754Medicaid
CT110000865Medicare ID - Type Unspecified
CT001193754Medicaid