Provider Demographics
NPI:1245307487
Name:SPENCER, HENRY J (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:J
Last Name:SPENCER
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 1:663 EAST MAIN ST.
Mailing Address - Street 2:UNIT 5
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790
Mailing Address - Country:US
Mailing Address - Phone:860-489-0227
Mailing Address - Fax:860-626-0039
Practice Address - Street 1:663 EAST MAIN ST.
Practice Address - Street 2:UNIT 5
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790
Practice Address - Country:US
Practice Address - Phone:860-489-0227
Practice Address - Fax:860-626-0039
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029055207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0V0114OtherHEALTHNET
010029055CT01OtherBCBS
C07414Medicare UPIN