Provider Demographics
NPI:1639568371
Name:SPELLMAN, MARY CLARE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:CLARE
Last Name:SPELLMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:28 MIGUEL ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-2606
Mailing Address - Country:US
Mailing Address - Phone:415-652-7962
Mailing Address - Fax:415-520-5533
Practice Address - Street 1:28 MIGUEL ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-2606
Practice Address - Country:US
Practice Address - Phone:415-652-7962
Practice Address - Fax:415-520-5533
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74771207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology