Provider Demographics
NPI:1043534290
Name:SPIEKER, JOSHUA L (RD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:L
Last Name:SPIEKER
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:80 SEYMOUR STREET PO BOX 5037
Mailing Address - Street 2:HARTFORD HOSPITAL
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06102-3765
Mailing Address - Country:US
Mailing Address - Phone:860-545-2697
Mailing Address - Fax:860-545-3765
Practice Address - Street 1:80 SEYMOUR ST
Practice Address - Street 2:HARTFORD HOSPITAL
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06102-3765
Practice Address - Country:US
Practice Address - Phone:860-545-2697
Practice Address - Fax:860-545-3765
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000840133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC00023Medicare PIN