Provider Demographics
NPI:1619985389
Name:SPIEGELMAN, KENNETH N (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:N
Last Name:SPIEGELMAN
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 1:230 CEDAR RIDGE TER
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1812
Mailing Address - Country:US
Mailing Address - Phone:860-643-7955
Mailing Address - Fax:
Practice Address - Street 1:27 HILLIARD ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-3001
Practice Address - Country:US
Practice Address - Phone:860-646-3903
Practice Address - Fax:860-645-3492
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT023393208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT023393OtherCT LIC#
CT023393OtherCT LIC#