Provider Demographics
NPI:1437136983
Name:SPITALE, MARIAN (RD)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:SPITALE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 W 3RD ST
Mailing Address - Street 2:APT. 43
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-4640
Mailing Address - Country:US
Mailing Address - Phone:716-450-3234
Mailing Address - Fax:
Practice Address - Street 1:75 JONES AND GIFFORD AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-2828
Practice Address - Country:US
Practice Address - Phone:716-450-3234
Practice Address - Fax:716-450-3234
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
866159133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA799861Medicare ID - Type Unspecified