Healthcare Provider Details

I. General information

NPI: 1356384515
Provider Name (Legal Business Name): AMANDA JOY SPIRO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S RIVER RD
BEDFORD NH
03110-6708
US

IV. Provider business mailing address

25 S RIVER RD
BEDFORD NH
03110-6708
US

V. Phone/Fax

Practice location:
  • Phone: 603-695-2572
  • Fax:
Mailing address:
  • Phone: 603-695-2572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number10457
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: