Provider Demographics
NPI:1033105457
Name:SPOTT, DAVID ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALLEN
Last Name:SPOTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9131 PISCATAWAY RD
Mailing Address - Street 2:SUITE # 550
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-2508
Mailing Address - Country:US
Mailing Address - Phone:301-868-7077
Mailing Address - Fax:301-856-0767
Practice Address - Street 1:9131 PISCATAWAY RD
Practice Address - Street 2:SUITE # 550
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2508
Practice Address - Country:US
Practice Address - Phone:301-868-7077
Practice Address - Fax:301-856-0767
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0015375207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB92767Medicare UPIN
MDG00028Medicare ID - Type Unspecified
MD000BB05D28Medicare ID - Type Unspecified