Provider Demographics
NPI:1265459119
Name:SPANARKEL, MARYBETH (MD)
Entity Type:Individual
Prefix:
First Name:MARYBETH
Middle Name:
Last Name:SPANARKEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 N DUKE ST
Mailing Address - Street 2:SUITE 503
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27704-3019
Mailing Address - Country:US
Mailing Address - Phone:919-479-0860
Mailing Address - Fax:919-479-5503
Practice Address - Street 1:2609 N DUKE ST
Practice Address - Street 2:SUITE 503
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27704-3019
Practice Address - Country:US
Practice Address - Phone:919-479-0860
Practice Address - Fax:919-479-5503
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC31388207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8978503Medicaid
NC210598BMedicare ID - Type Unspecified
NC8978503Medicaid