Healthcare Provider Details

I. General information

NPI: 1144206699
Provider Name (Legal Business Name): SPENCER G ERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2005
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

339 W MAIN ST HARTFORD MEDICAL GROUP
AVON CT
06001-4322
US

IV. Provider business mailing address

339 W MAIN ST HARTFORD MEDICAL GROUP
AVON CT
06001-4322
US

V. Phone/Fax

Practice location:
  • Phone: 860-696-2150
  • Fax: 860-696-2160
Mailing address:
  • Phone: 860-696-2150
  • Fax: 860-696-2160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number029344
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: