Provider Demographics
NPI:1063489961
Name:SPILLANE, JEFFREY J (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:SPILLANE
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 1:100 CAMP ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3007
Mailing Address - Country:US
Mailing Address - Phone:508-775-1984
Mailing Address - Fax:508-790-1897
Practice Address - Street 1:100 CAMP ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3007
Practice Address - Country:US
Practice Address - Phone:508-428-6219
Practice Address - Fax:508-790-1897
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA219914208600000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000029633OtherBOSTON MEDICAL CENT HP
MAAA10594OtherHARVARD PILGRIM HEALTH
MDJ27150OtherBCBS
MA2041472Medicaid
MAP00162754OtherRAILROAD MEDICARE
MA468726OtherTUFTS HEALTH PLAN
MDJ27150OtherBCBS
G10351Medicare UPIN