Healthcare Provider Details

I. General information

NPI: 1225093529
Provider Name (Legal Business Name): DAVID D. SPENCER D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 05/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 GAINSBOROUGH SQ STE 400
CHESAPEAKE VA
23320-1713
US

IV. Provider business mailing address

113 GAINSBOROUGH SQ STE 400
CHESAPEAKE VA
23320-1713
US

V. Phone/Fax

Practice location:
  • Phone: 757-842-4499
  • Fax: 757-842-1447
Mailing address:
  • Phone: 757-842-4499
  • Fax: 757-842-1447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0102201265
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: