Provider Demographics
NPI:1457798811
Name:CARTER SPAGNOLO, COURTNEY ROCHELLE (DO)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:ROCHELLE
Last Name:CARTER SPAGNOLO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:ROCHELLE
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:9202 CENTER OAK CT
Mailing Address - Street 2:
Mailing Address - City:MECHANCSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116
Mailing Address - Country:US
Mailing Address - Phone:804-730-0432
Mailing Address - Fax:866-449-0896
Practice Address - Street 1:9202 CENTER OAK CT
Practice Address - Street 2:
Practice Address - City:MECHANCSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116
Practice Address - Country:US
Practice Address - Phone:804-730-0432
Practice Address - Fax:866-449-0896
Is Sole Proprietor?:No
Enumeration Date:2013-05-25
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01022053902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry