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General NPI Number Information
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NPI Number | 1053215574
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Entity Type | Individual
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Provider Name | MR. SPENCER GUSTAVE SCHALLER
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Gender | Male
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Dates
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Enumeration Date | 10/07/2026
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Last Update Date | 10/07/2026
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Provider Practice Location Address
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Address Line | 275 NEW STATE RD
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City | MANCHESTER
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State | CT
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Zip | 06042-1810
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Country | US
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Telephone | 860-647-9798
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Fax |
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Provider Business Mailing Address
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Address Line | 76 FAR HILLS DR
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City | AVON
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State | CT
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Zip | 06001-2877
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Country | US
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Telephone | 860-948-8686
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 146L00000X
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Taxonomy Name | Paramedic
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License Number | 4586
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License Number State | CT
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