Provider Demographics
NPI:1669565388
Name:SPINA, MARGUERITE B (CFM)
Entity type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:B
Last Name:SPINA
Suffix:
Gender:F
Credentials:CFM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 DOWNINGTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-1951
Mailing Address - Country:US
Mailing Address - Phone:610-692-7544
Mailing Address - Fax:610-696-1126
Practice Address - Street 1:961 DOWNINGTOWN PIKE
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-1951
Practice Address - Country:US
Practice Address - Phone:610-692-7544
Practice Address - Fax:610-696-1126
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAN/A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1219130001Medicare ID - Type UnspecifiedPROVIDER ID NUMBER