Healthcare Provider Details

I. General information

NPI: 1013956648
Provider Name (Legal Business Name): H TODD SPENCER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: HAVEN TODD SPENCER MD

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 08/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 STATE HWY RTE 6
WELLFLEET MA
02667-7402
US

IV. Provider business mailing address

PO BOX 1413
WELLFLEET MA
02667-1413
US

V. Phone/Fax

Practice location:
  • Phone: 508-349-3131
  • Fax: 508-349-1311
Mailing address:
  • Phone: 508-905-2800
  • Fax: 508-240-1244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number55833
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: