Provider Demographics
NPI:1619922648
Name:SPREMULLI, ELLEN N (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:N
Last Name:SPREMULLI
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:PO BOX 18428
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35804-8428
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 LEIGHTON AVE
Practice Address - Street 2:SUITE 602
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5700
Practice Address - Country:US
Practice Address - Phone:256-238-1011
Practice Address - Fax:256-238-4366
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00011380207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529501680Medicaid
AL51083226OtherBLUE CROSS ID#
AL110232615OtherMEDICARE RAILROAD
AL51083226OtherBLUE CROSS ID#
AL110232615OtherMEDICARE RAILROAD