Provider Demographics
NPI:1720076680
Name:SPENCER, PATRICIA K (MD)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:K
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CATAMORE BLVD
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-1204
Mailing Address - Country:US
Mailing Address - Phone:401-432-2520
Mailing Address - Fax:401-432-2457
Practice Address - Street 1:20 CATAMORE BLVD
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1204
Practice Address - Country:US
Practice Address - Phone:401-432-2520
Practice Address - Fax:401-432-2457
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI58312085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000001988OtherNHPRI
005831OtherBLUESHIELD
7000445OtherRIMEDICALASSISTANCE
005831OtherTUFTS
1600203OtherUNITEDHEALTHPLANS
240159OtherRIHPILGRIM
5831OtherFEPBLUECROSS
004370OtherBLUECHIPSENIORS
6192238OtherHEALTHYSTART
6192238OtherMASSMEDICAID
004370OtherBLUECHIP
5831OtherFEPBLUECROSS