Provider Demographics
NPI:1326354010
Name:CHRISTOPHER N. SPELLMAN, M.D., INC.
Entity Type:Organization
Organization Name:CHRISTOPHER N. SPELLMAN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:NAWN
Authorized Official - Last Name:SPELLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-799-3699
Mailing Address - Street 1:6221 METROPOLITAN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-3096
Mailing Address - Country:US
Mailing Address - Phone:760-633-3377
Mailing Address - Fax:760-633-3370
Practice Address - Street 1:6221 METROPOLITAN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-3096
Practice Address - Country:US
Practice Address - Phone:760-633-3377
Practice Address - Fax:760-633-3370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA95995207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02655498Medicaid
504A11Medicare PIN
NY02655498Medicaid