Healthcare Provider Details

I. General information

NPI: 1114983871
Provider Name (Legal Business Name): AARON C SPALDING MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 DUTCHMANS LANE SUITE G02
LOUISVILLE KY
40207
US

IV. Provider business mailing address

315 E BROADWAY
LOUISVILLE KY
40202-3700
US

V. Phone/Fax

Practice location:
  • Phone: 502-899-6601
  • Fax: 502-899-6630
Mailing address:
  • Phone: 502-629-2500
  • Fax: 502-629-2055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01059740A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number4301081806
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: