Provider Demographics
NPI:1629140843
Name:SPENGLER, KENNETH C (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:C
Last Name:SPENGLER
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:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-0655
Mailing Address - Country:US
Mailing Address - Phone:603-778-7975
Mailing Address - Fax:603-778-7964
Practice Address - Street 1:3 ALUMNI DR
Practice Address - Street 2:STE 301
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833-2128
Practice Address - Country:US
Practice Address - Phone:603-778-7975
Practice Address - Fax:603-778-7964
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5533207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH00000559Medicaid
0104377Y0NH01OtherANTHEM BS
020336308OtherTAX ID#
100833000OtherUS DEPARTMENT OF LABOR
200007671OtherRAILROAD MEDICARE
0904133OtherUNITED HEALTHCARE
4680OtherCIGNA NH
0122210OtherAETNA
0904133OtherUNITED HEALTHCARE
0122210OtherAETNA
NH00000559Medicaid