Provider Demographics
NPI:1093802894
Name:SPADARO, FABIO (MD)
Entity Type:Individual
Prefix:DR
First Name:FABIO
Middle Name:
Last Name:SPADARO
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 1:8600 BATAAN MEMORIAL E
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-6016
Mailing Address - Country:US
Mailing Address - Phone:575-373-9202
Mailing Address - Fax:575-373-9592
Practice Address - Street 1:8600 BATAAN MEMORIAL E
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-6016
Practice Address - Country:US
Practice Address - Phone:505-988-1232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301106375207Q00000X
AZ44320207Q00000X
NMMD2006-0489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4301106375OtherSTATE LICENSE