Provider Demographics
NPI:1326131988
Name:STEPHEN SPAULDING MD
Entity Type:Organization
Organization Name:STEPHEN SPAULDING MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPAULDING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-535-6080
Mailing Address - Street 1:116 NORTH CATHERINE STREET
Mailing Address - Street 2:
Mailing Address - City:MOUNT FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14865
Mailing Address - Country:US
Mailing Address - Phone:607-535-6080
Mailing Address - Fax:607-535-9613
Practice Address - Street 1:116 NORTH CATHERINE STREET
Practice Address - Street 2:
Practice Address - City:MOUNT FALLS
Practice Address - State:NY
Practice Address - Zip Code:14865
Practice Address - Country:US
Practice Address - Phone:607-535-6080
Practice Address - Fax:607-535-9613
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1890281207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56424AMedicare PIN