Provider Demographics
NPI:1265538979
Name:SPADA, PAUL THOMAS (DPM)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:THOMAS
Last Name:SPADA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 RODNEY LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-2227
Mailing Address - Country:US
Mailing Address - Phone:757-560-9388
Mailing Address - Fax:757-523-9476
Practice Address - Street 1:533 RODNEY LN
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-2227
Practice Address - Country:US
Practice Address - Phone:757-560-9388
Practice Address - Fax:757-523-9476
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000983213ES0131X
PASC0032299L213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA330051OtherBC/BS #
VA009300449Medicaid
VA480027059OtherRAILROAD M/C #
VAU26131Medicare UPIN
VA480000505Medicare ID - Type Unspecified