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General NPI Number Information
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NPI Number | 1134228281
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Entity Type | Individual
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Provider Name | MATTHEW J SPATES MD
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Gender | Male
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Dates
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Enumeration Date | 09/22/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 326 WASHINGTON ST THE WILLIAM W. BACKUS HOSPITAL
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City | NORWICH
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State | CT
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Zip | 06360-2740
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Country | US
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Telephone | 860-889-8331
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Fax |
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Provider Business Mailing Address
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Address Line | 66 MAIN ST
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City | STONINGTON
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State | CT
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Zip | 06378-1332
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Country | US
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Telephone | 401-749-2064
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 039491
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License Number State | CT
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