Provider Demographics
NPI:1184689184
Name:SPALDING, RICHARD M (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:M
Last Name:SPALDING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 766351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:2051 CLEVIDENCE BLVD
Practice Address - Street 2:STE. 1
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-2278
Practice Address - Country:US
Practice Address - Phone:812-280-9145
Practice Address - Fax:812-280-6627
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01034874A207R00000X
KY20244207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100191730Medicaid
2445888000OtherPAD - NCMA
50004526OtherPASSPORT -NCMA
120321POtherSIHO - NCMA
KY64202443Medicaid
KYP00711467OtherRAILROAD MEDICARE KY
1193933OtherCHA / NCMA
00000050972OtherANTHEM - NCMA
2559361-001OtherCIGNA / NCMA
IN110138279OtherRAILROAD MEDICARE
IN110138279OtherRAILROAD MEDICARE
KYP00711467OtherRAILROAD MEDICARE KY
KY64202443Medicaid