Provider Demographics
NPI:1588630974
Name:SPIRO, STACY JOANNE (MD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:JOANNE
Last Name:SPIRO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 WOODLAND ST FL 4
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-1230
Mailing Address - Country:US
Mailing Address - Phone:860-648-2748
Mailing Address - Fax:860-648-2751
Practice Address - Street 1:1050 SULLIVAN AVE
Practice Address - Street 2:SUITE A4
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2000
Practice Address - Country:US
Practice Address - Phone:860-648-2748
Practice Address - Fax:860-648-2751
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042644207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H61228Medicare UPIN