Provider Demographics
NPI:1265404818
Name:SPAGNOLA, NICHOLAS J (DO)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:J
Last Name:SPAGNOLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 PERSIMMON LN
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1777
Mailing Address - Country:US
Mailing Address - Phone:717-757-6920
Mailing Address - Fax:717-406-1923
Practice Address - Street 1:829 PERSIMMON LN
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1777
Practice Address - Country:US
Practice Address - Phone:717-757-6920
Practice Address - Fax:717-406-1923
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004875L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA039846OtherGROUP PTAN
PA00863283Medicaid
PA086456N84Medicare ID - Type Unspecified
PA080186919Medicare PIN
PA039846OtherGROUP PTAN