Healthcare Provider Details

I. General information

NPI: 1801078126
Provider Name (Legal Business Name): CEWARD RANDALL SPANGLER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1976 S MILITARY HWY
CHESAPEAKE VA
23320-4415
US

IV. Provider business mailing address

1976 S MILITARY HWY
CHESAPEAKE VA
23320-4415
US

V. Phone/Fax

Practice location:
  • Phone: 757-545-6934
  • Fax:
Mailing address:
  • Phone: 757-545-6934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: