Provider Demographics
NPI:1558303727
Name:SPELLMAN, EDWARD LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LEWIS
Last Name:SPELLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1615 ORANGE TREE LN
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4501
Mailing Address - Country:US
Mailing Address - Phone:909-786-0725
Mailing Address - Fax:
Practice Address - Street 1:7000 BOULDER AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346
Practice Address - Country:US
Practice Address - Phone:909-862-1191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2018-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0318602084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
250952200OtherDEPT OF LABOR
061325634OtherCOMM INS
061325634OtherUNITED HEALTH
010031860CT01OtherBLUE CROSS ANTHEM
061325634OtherCHAMPUS
140400OtherWORK COMP
NHS133OtherOXFORD
031860OtherCONNECTI CARE
130009173OtherRR MEDICARE
CT001318600Medicaid
00131860000OtherBLUE CROSS FAMILY PLAN
0983647004OtherCIGNA
061325634OtherCOMMUNITY HEALTH
06132S634OtherAETNA
0613Z5634OtherFIRST HEALTH
OR0088OtherHEALTHNET