Provider Demographics
NPI:1538143797
Name:SPENCER, CHRISTOPHER B (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:B
Last Name:SPENCER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 417297
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-7297
Mailing Address - Country:US
Mailing Address - Phone:866-623-3869
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:111 GOOSE LN
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-5101
Practice Address - Country:US
Practice Address - Phone:203-453-7100
Practice Address - Fax:215-957-2875
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT039597207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001395971Medicaid
CT001395971Medicaid
H38581Medicare UPIN