Provider Demographics
NPI:1932430600
Name:RICHARD L. SPINNER DPM PC
Entity Type:Organization
Organization Name:RICHARD L. SPINNER DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SPINNER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:570-424-6928
Mailing Address - Street 1:1101 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-2659
Mailing Address - Country:US
Mailing Address - Phone:570-424-6928
Mailing Address - Fax:570-421-5472
Practice Address - Street 1:1101 N 5TH ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-2659
Practice Address - Country:US
Practice Address - Phone:570-424-6928
Practice Address - Fax:570-421-5472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC-002046-L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28462Medicare UPIN