Healthcare Provider Details

I. General information

NPI: 1609857424
Provider Name (Legal Business Name): MARC EDWARD SPULLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 431 DARMSTADT HEALTH CLINIC
APO AE
09175
DE

IV. Provider business mailing address

CMR 431 BOX 919
APO AE
09175
DE

V. Phone/Fax

Practice location:
  • Phone: 4906151696474
  • Fax:
Mailing address:
  • Phone: 49061556009216
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35047490
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number28303
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: