Provider Demographics
NPI:1225093529
Name:SPENCER, DAVID D (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:D
Last Name:SPENCER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 GAINSBOROUGH SQ
Mailing Address - Street 2:STE 400
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1713
Mailing Address - Country:US
Mailing Address - Phone:757-842-4499
Mailing Address - Fax:757-842-1447
Practice Address - Street 1:113 GAINSBOROUGH SQ
Practice Address - Street 2:STE 400
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1713
Practice Address - Country:US
Practice Address - Phone:757-842-4499
Practice Address - Fax:757-842-1447
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102201265208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007314256Medicaid
VA007314256Medicaid
VAH81012Medicare UPIN
GC1014Medicare PIN