Provider Demographics
NPI:1083763007
Name:SPALDING, TOM (PA)
Entity Type:Individual
Prefix:
First Name:TOM
Middle Name:
Last Name:SPALDING
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 FRASIER ST
Mailing Address - Street 2:TRIANGLE UROLOGY ASSOCIATES, P.A.
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-2125
Mailing Address - Country:US
Mailing Address - Phone:919-477-7003
Mailing Address - Fax:919-471-2827
Practice Address - Street 1:205 FRASIER ST
Practice Address - Street 2:TRIANGLE UROLOGY ASSOCIATES, P.A.
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-2125
Practice Address - Country:US
Practice Address - Phone:919-477-7003
Practice Address - Fax:919-471-2827
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100697208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
S76006Medicare ID - Type Unspecified
NC2751559Medicare ID - Type Unspecified