Healthcare Provider Details

I. General information

NPI: 1164650321
Provider Name (Legal Business Name): DANIEL B SPENCER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2009
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 HOLMES RD
RIDGEFIELD CT
06877-4304
US

IV. Provider business mailing address

133 HOLMES RD
RIDGEFIELD CT
06877-4304
US

V. Phone/Fax

Practice location:
  • Phone: 475-289-6939
  • Fax:
Mailing address:
  • Phone: 475-289-6939
  • Fax: 203-884-0048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101265999
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number079108
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101265999
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101265999
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: