Provider Demographics
NPI:1760499636
Name:ALAN M SPAGNOLA, MD, PC
Entity Type:Organization
Organization Name:ALAN M SPAGNOLA, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SPAGNOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-767-0145
Mailing Address - Street 1:10 WILDWOOD MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426-1154
Mailing Address - Country:US
Mailing Address - Phone:860-767-0145
Mailing Address - Fax:860-767-0021
Practice Address - Street 1:10 WILDWOOD MEDICAL CTR
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426-1154
Practice Address - Country:US
Practice Address - Phone:860-767-0145
Practice Address - Fax:860-767-0021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT019375207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Not Answered207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B83995Medicare UPIN