Provider Demographics
NPI:1033161088
Name:SPILLANE, ROBERT M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:SPILLANE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:18 BAINBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1101
Mailing Address - Country:US
Mailing Address - Phone:860-289-3375
Mailing Address - Fax:860-560-2849
Practice Address - Street 1:111 FOUNDERS PLZ
Practice Address - Street 2:SUITE 400
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-3212
Practice Address - Country:US
Practice Address - Phone:860-289-3375
Practice Address - Fax:860-560-2849
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0419012085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1033161088Medicaid
CT940000025Medicare PIN