Provider Demographics
NPI:1598084451
Name:SPARE, NICOLE MARIE (DO)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARIE
Last Name:SPARE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 WALNUT ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5509
Mailing Address - Country:US
Mailing Address - Phone:215-955-2243
Mailing Address - Fax:215-955-2060
Practice Address - Street 1:900 WALNUT ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5509
Practice Address - Country:US
Practice Address - Phone:215-955-2243
Practice Address - Fax:215-955-2060
Is Sole Proprietor?:No
Enumeration Date:2010-05-18
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS016754208100000X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation