Provider Demographics
NPI:1275604159
Name:PHYLLIS N SPIELER MD
Entity Type:Organization
Organization Name:PHYLLIS N SPIELER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:NAOMI
Authorized Official - Last Name:SPIELER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-470-1902
Mailing Address - Street 1:138 HAVERHILL ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810
Mailing Address - Country:US
Mailing Address - Phone:978-470-1902
Mailing Address - Fax:978-749-3605
Practice Address - Street 1:138 HAVERHILL ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810
Practice Address - Country:US
Practice Address - Phone:978-470-1902
Practice Address - Fax:978-749-3605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45717207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0110213Medicaid
D82806Medicare UPIN
D02062Medicare PIN