Provider Demographics
NPI:1326139379
Name:SPENCER, WILLIAM R (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:SPENCER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:23 FORT SALONGA RD
Mailing Address - Street 2:
Mailing Address - City:CENTERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11721-1603
Mailing Address - Country:US
Mailing Address - Phone:631-754-5707
Mailing Address - Fax:631-760-2000
Practice Address - Street 1:25 E CARVER ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3409
Practice Address - Country:US
Practice Address - Phone:631-424-1887
Practice Address - Fax:631-760-2000
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2010-10-20
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Provider Licenses
StateLicense IDTaxonomies
NY204961207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02090068Medicaid
NY02090068Medicaid