Healthcare Provider Details

I. General information

NPI: 1235178328
Provider Name (Legal Business Name): SPENCER R AMESBURY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 CUMMINGS CTR SUITE 218U
BEVERLY MA
01915-6198
US

IV. Provider business mailing address

43 LABOR IN VAIN RD
IPSWICH MA
01938-2623
US

V. Phone/Fax

Practice location:
  • Phone: 978-922-3622
  • Fax:
Mailing address:
  • Phone: 978-922-3622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number71681
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number71681
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number71681
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number71681
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: