Provider Demographics
NPI:1144206699
Name:ERMAN, SPENCER G (MD)
Entity Type:Individual
Prefix:DR
First Name:SPENCER
Middle Name:G
Last Name:ERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:339 W MAIN ST
Mailing Address - Street 2:HARTFORD MEDICAL GROUP
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-4322
Mailing Address - Country:US
Mailing Address - Phone:860-696-2150
Mailing Address - Fax:860-696-2160
Practice Address - Street 1:339 W MAIN ST
Practice Address - Street 2:HARTFORD MEDICAL GROUP
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-4322
Practice Address - Country:US
Practice Address - Phone:860-696-2150
Practice Address - Fax:860-696-2160
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT029344207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001293448Medicaid
CT001293448Medicaid
E40475Medicare UPIN