Healthcare Provider Details

I. General information

NPI: 1609867449
Provider Name (Legal Business Name): DOUGLAS A. SPOTTS, MD FAMILY MEDICAL CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 FORESTWOOD DR
LEWISBURG PA
17837-6213
US

IV. Provider business mailing address

45 FORESTWOOD DR
LEWISBURG PA
17837-6213
US

V. Phone/Fax

Practice location:
  • Phone: 570-524-5050
  • Fax: 570-524-5250
Mailing address:
  • Phone: 570-524-5050
  • Fax: 570-524-5250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberMD058238L
License Number StatePA

VIII. Authorized Official

Name: DR. DOUGLAS ALAN SPOTTS
Title or Position: OWNER
Credential: M.D.
Phone: 570-524-5050