Provider Demographics
NPI:1801078126
Name:SPANGLER, CEWARD RANDALL JR
Entity type:Individual
Prefix:
First Name:CEWARD
Middle Name:RANDALL
Last Name:SPANGLER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1976 S MILITARY HWY
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4415
Mailing Address - Country:US
Mailing Address - Phone:757-545-6934
Mailing Address - Fax:
Practice Address - Street 1:1976 S MILITARY HWY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4415
Practice Address - Country:US
Practice Address - Phone:757-545-6934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies