Provider Demographics
NPI:1700098480
Name:RICHARD A SPITZER MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:RICHARD A SPITZER MD A MEDICAL CORPORATION
Other - Org Name:RICHARD A. SPITZER, M.D.,INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:SPITZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-449-1814
Mailing Address - Street 1:50 ALESSANDRO PLACE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-4010
Mailing Address - Country:US
Mailing Address - Phone:626-449-1814
Mailing Address - Fax:626-449-0007
Practice Address - Street 1:50 ALESSANDRO PLACE
Practice Address - Street 2:SUITE 120
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-4010
Practice Address - Country:US
Practice Address - Phone:626-449-1814
Practice Address - Fax:626-449-0007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G190180Medicaid
CADN7881OtherRAILROAD MEDICARE
CADN7881OtherRAILROAD MEDICARE