Provider Demographics
NPI:1740525583
Name:MARIO A. SPOTO, D.C., P.C.
Entity type:Organization
Organization Name:MARIO A. SPOTO, D.C., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:A
Authorized Official - Last Name:SPOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC, PC
Authorized Official - Phone:610-269-7662
Mailing Address - Street 1:305 E LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNINGTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19335-5903
Mailing Address - Country:US
Mailing Address - Phone:610-269-7662
Mailing Address - Fax:610-873-1255
Practice Address - Street 1:305 E LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:DOWNINGTOWN
Practice Address - State:PA
Practice Address - Zip Code:19335-5903
Practice Address - Country:US
Practice Address - Phone:610-269-7662
Practice Address - Fax:610-873-1255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-05
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC001967L302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASPO065339OtherBCBS
PA51145OtherAETNA
PA0026945000OtherINDEPENDENCE BLUE CROSS
PASPO065339OtherBCBS