Provider Demographics
NPI:1134199938
Name:SPAGNOLETTI, ALLISON A (PA)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:A
Last Name:SPAGNOLETTI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 SAMARITANS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ELKIN
Mailing Address - State:NC
Mailing Address - Zip Code:28621-2452
Mailing Address - Country:US
Mailing Address - Phone:336-835-7700
Mailing Address - Fax:336-527-1071
Practice Address - Street 1:124 SAMARITANS RIDGE RD
Practice Address - Street 2:
Practice Address - City:ELKIN
Practice Address - State:NC
Practice Address - Zip Code:28621-2452
Practice Address - Country:US
Practice Address - Phone:336-835-7700
Practice Address - Fax:336-527-1071
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101771363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
2752457Medicare ID - Type Unspecified
S87839Medicare UPIN