Healthcare Provider Details

I. General information

NPI: 1558426890
Provider Name (Legal Business Name): JEFFREY VAHAN SPENCER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 09/07/2022
Certification Date: 09/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1647 WOODBROOKE DR
SALISBURY MD
21804-8502
US

IV. Provider business mailing address

PO BOX 1978
SALISBURY MD
21802-1978
US

V. Phone/Fax

Practice location:
  • Phone: 410-546-2424
  • Fax: 410-742-6633
Mailing address:
  • Phone: 410-749-1015
  • Fax: 410-749-0654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberD0068726
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: