Healthcare Provider Details

I. General information

NPI: 1932640356
Provider Name (Legal Business Name): TED ANDREW SPIEWAK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2017
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 NEALY AVE
LANGLEY AFB VA
23665-2040
US

IV. Provider business mailing address

77 NEALY AVE
LANGLEY AFB VA
23665-2040
US

V. Phone/Fax

Practice location:
  • Phone: 757-225-5647
  • Fax: 757-764-2406
Mailing address:
  • Phone: 757-225-5647
  • Fax: 757-764-2406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number213523
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: