Provider Demographics
NPI:1073553707
Name:SPECTOR, SCOTT M (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:M
Last Name:SPECTOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:488 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-1008
Mailing Address - Country:US
Mailing Address - Phone:203-853-9900
Mailing Address - Fax:203-853-1359
Practice Address - Street 1:488 MAIN AVE STE 2
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-1008
Practice Address - Country:US
Practice Address - Phone:203-853-9000
Practice Address - Fax:203-853-1359
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY154953207W00000X
CT029656207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010029656CT01OtherBLUECROSS BLUESHIELD
180007065OtherRAILROAD MEDICARE
CT010029656CT01OtherBLUECROSS BLUESHIELD
CT180000378Medicare ID - Type Unspecified
CT010029656CT01OtherBLUECROSS BLUESHIELD