MEDICARE: JOSEPH D SPATARO MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician		NC

General Provider Information

NPI Number	:	1932398294
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH D SPATARO MD PC

Provider Business Mailing Address
First Line	:	6101 IDLEWILD RD
Second Line	:	SUITE 300
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-0517
Country	:	US
Telephone Number	:	704-531-0990
Fax Number	:	704-531-0464

Provider Business Practice Location Address
First Line	:	6101 IDLEWILD RD
Second Line	:	SUITE 300
City	:	CHARLOTTE
State	:	NC
Zip	:	28212-0517
Country	:	US
Telephone Number	:	704-531-0990
Fax Number	:	704-531-0464

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOSEPH DAVID SPATARO
Credential	:	MD
Telephone Number	:	704-531-0990

Provider Enumeration Date	:	10/23/2007
Last Update Date	:	10/23/2007

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