Healthcare Provider Details

I. General information

NPI: 1750367884
Provider Name (Legal Business Name): ANDREW RYAN SPECTOR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 07/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 CANTON ST
MANCHESTER NH
03103-3524
US

IV. Provider business mailing address

30 CANTON ST
MANCHESTER NH
03103-3524
US

V. Phone/Fax

Practice location:
  • Phone: 603-622-3623
  • Fax: 603-625-5483
Mailing address:
  • Phone: 603-622-3623
  • Fax: 603-625-5483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number12632
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: