Provider Demographics
NPI:1265475024
Name:SPIEGLER, ETHAN J (MD)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:J
Last Name:SPIEGLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7253 AMBASSADOR RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2710
Mailing Address - Country:US
Mailing Address - Phone:443-436-1116
Mailing Address - Fax:443-436-1256
Practice Address - Street 1:7253 AMBASSADOR RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2710
Practice Address - Country:US
Practice Address - Phone:443-436-1116
Practice Address - Fax:443-436-1256
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00345022085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA445401400Medicaid
MD360004276Medicare PIN
MD527L649CMedicare PIN
MD301LA551Medicare PIN
D74747Medicare UPIN
MA445401400Medicaid