Healthcare Provider Details

I. General information

NPI: 1902010580
Provider Name (Legal Business Name): STEPHANIE S. SPANGLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 HILLHOUSE AVE
NEW HAVEN CT
06511-6815
US

IV. Provider business mailing address

66 DEEPWOOD DR
GUILFORD CT
06437-3211
US

V. Phone/Fax

Practice location:
  • Phone: 203-432-0076
  • Fax: 203-432-8139
Mailing address:
  • Phone: 203-432-4446
  • Fax: 203-432-8139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number021742
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: