Provider Demographics
NPI:1881630804
Name:SPINELLA, MARTIN JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:JOSEPH
Last Name:SPINELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:60 WESTWOOD AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2460
Mailing Address - Country:US
Mailing Address - Phone:203-574-4930
Mailing Address - Fax:203-574-5987
Practice Address - Street 1:60 WESTWOOD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2460
Practice Address - Country:US
Practice Address - Phone:203-574-4930
Practice Address - Fax:203-574-5987
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT025534207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001255348Medicaid
CTB38178Medicare UPIN
CT001255348Medicaid