Provider Demographics
NPI:1932398294
Name:JOSEPH D SPATARO MD PC
Entity Type:Organization
Organization Name:JOSEPH D SPATARO MD PC
Other - Org Name:IDLEWILD MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SPATARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-531-0990
Mailing Address - Street 1:6101 IDLEWILD RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28212-0517
Mailing Address - Country:US
Mailing Address - Phone:704-531-0990
Mailing Address - Fax:704-531-0464
Practice Address - Street 1:6101 IDLEWILD RD
Practice Address - Street 2:SUITE 300
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-0517
Practice Address - Country:US
Practice Address - Phone:704-531-0990
Practice Address - Fax:704-531-0464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2345466Medicare PIN