Healthcare Provider Details

I. General information

NPI: 1689679425
Provider Name (Legal Business Name): BRAD VINCENT SPAGNOLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PRINCE FREDERICK BLVD
PRINCE FREDERICK MD
20678-3145
US

IV. Provider business mailing address

2661 RIVA RD STE 1030
ANNAPOLIS MD
21401-7131
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-2270
  • Fax: 800-515-9426
Mailing address:
  • Phone: 410-571-8733
  • Fax: 410-571-6309

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD0056098
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: