Provider Demographics
NPI:1336797182
Name:SPESSARD, LORETTA IRENE
Entity Type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:IRENE
Last Name:SPESSARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 TRAFALGAR DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-1230
Mailing Address - Country:US
Mailing Address - Phone:301-797-1885
Mailing Address - Fax:
Practice Address - Street 1:664 TRAFALGAR DR
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-1230
Practice Address - Country:US
Practice Address - Phone:017-971-8853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-26
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA