Provider Demographics
NPI:1477664795
Name:SPENCER, SUSAN J (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:J
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:101 S SAN MATEO DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3819
Mailing Address - Country:US
Mailing Address - Phone:650-344-7799
Mailing Address - Fax:640-344-7802
Practice Address - Street 1:101 S SAN MATEO DR
Practice Address - Street 2:SUITE 112
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3819
Practice Address - Country:US
Practice Address - Phone:650-344-7799
Practice Address - Fax:640-344-7802
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-07-01
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Provider Licenses
StateLicense IDTaxonomies
CAG065695207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F74647Medicare UPIN