Healthcare Provider Details

I. General information

NPI: 1659965184
Provider Name (Legal Business Name): MICHAEL DAVID SPENCER MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2021
Last Update Date: 02/25/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1082 DAVOL ST
FALL RIVER MA
02720-1124
US

IV. Provider business mailing address

1082 DAVOL ST
FALL RIVER MA
02720-1124
US

V. Phone/Fax

Practice location:
  • Phone: 508-678-2833
  • Fax: 508-675-9640
Mailing address:
  • Phone: 508-678-2833
  • Fax: 508-675-9640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: