Provider Demographics
NPI:1124220090
Name:SPAEDER, GWYNETH ANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:GWYNETH
Middle Name:ANNE
Last Name:SPAEDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GWYNETH
Other - Middle Name:ANNE
Other - Last Name:SUSIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2000 PERIMETER PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10831 FOREST PINES DR STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-8077
Practice Address - Country:US
Practice Address - Phone:919-782-5273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-04
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-01880208000000X
MD20400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics