Provider Demographics
NPI:1134122112
Name:SPANDORFER, MICHAEL ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALAN
Last Name:SPANDORFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 751649
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1649
Mailing Address - Country:US
Mailing Address - Phone:843-789-1620
Mailing Address - Fax:843-724-2440
Practice Address - Street 1:2097 HENRY TECKLENBURG DR
Practice Address - Street 2:STE 305
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5744
Practice Address - Country:US
Practice Address - Phone:843-763-3360
Practice Address - Fax:843-763-3038
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20019207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP00799634OtherRAILROAD MC ID-RSFPN
SC200197Medicaid
SCP00799634OtherRAILROAD MC ID-RSFPN