Healthcare Provider Details

I. General information

NPI: 1023695277
Provider Name (Legal Business Name): ROBERT SPENCER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2021
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 BROADWAY
BANGOR ME
04401-3900
US

IV. Provider business mailing address

47 NEW SCOTLAND AVENUE, DEPT. OF GENERAL SURGERY
ALBANY NY
12208
US

V. Phone/Fax

Practice location:
  • Phone: 207-907-1000
  • Fax:
Mailing address:
  • Phone: 518-262-5374
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD30458
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: