Provider Demographics
NPI:1295785251
Name:SPELLUN, JOEL S (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:S
Last Name:SPELLUN
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 1:148 W RIVER ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-2609
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:148 W RIVER ST
Practice Address - Street 2:SUITE 3
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-2609
Practice Address - Country:US
Practice Address - Phone:401-421-6306
Practice Address - Fax:401-453-0330
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI7075207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7003005Medicaid
RI007003005Medicare ID - Type Unspecified
RIC90032Medicare UPIN