Healthcare Provider Details

I. General information

NPI: 1174732200
Provider Name (Legal Business Name): THOMAS CHRISTOPHER SPALLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 03/22/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COOPER PLZ
CAMDEN NJ
08103-1438
US

IV. Provider business mailing address

456 N 5TH ST SUITE 3
PHILADELPHIA PA
19123
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-3113
  • Fax:
Mailing address:
  • Phone: 215-273-3223
  • Fax: 215-714-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD440916
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number25MA09190600
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberMD440916
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: